Data Analyst - Remote

About the Role

Key Responsibilities

• Identify potential concepts for retrospective and prospective savings through individual ideation and from several perspectives such as correct network contracting, policy reimbursement, medical documentation requirements, industry and federal guidelines.
• Identify root causes to shift the retrospective saving to prepay and further stages in the claim life cycle in the form of avoidance, automated prevention and manual prevention solutions.
• Work collaboratively with business partners, SMEs, and BAs to ensure a shared understanding of business requirements.
• Pull data of overpayment/claim paid data, size the Shift Left opportunity, socialize ideas with different payment integrity solutioning teams and build relationships to deliver results.
• Examine, assess, and document business operations and procedures to ensure operational efficiency and excellence.
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance.
• Use pertinent data and facts to ideate, identify and solve a range of problems within area of expertise.
• Develop and maintain technical and user documentation.
• Create output from Excel to Power BI from data analysis for client approval.
• Comply with design and coding standards, policies, and procedures.
• Manage concepts from deployment to implementation.
• Communicate the outcome of research in a manner suitable for the intended audience.
• Assist management with post-deployment reporting.
• Work with less structured, more complex issues.
• Leverage new technologies to drive innovation in healthcare data analytics and meet emerging customer requirements.
• Work independently and collaborate across diverse and matrixed teams.

Requirements

• 5+ years of data analysis and/or audit experience within the healthcare industry.
• 4+ years of experience using C&S claims adjudication platforms.
• 3+ years of experience in managing cross-functional projects and making presentations.
• 3+ years of experience pulling data using SQL or Python.
• 2+ years of experience working with processing Post-pay or Prepay payment integrity.

Nice to Have

• Solid organizational and interpersonal skills.
• Intermediate proficiency in MS Excel, Word, and PowerPoint.
• Working knowledge of COSMOS, FACETS.
• Agile trained (or willingness to undergo agile training).
• Experience working in a virtual environment.
• Beginner proficiency in MS Visio and Access.

Qualifications

• Formal educational qualifications are not explicitly specified in the description.

Benefits & Perks

• Competitive salary range of $71,600 to $140,600 annually based on full-time employment and various factors.
• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase options.
• 401k contribution.