Operations Data Analyst II

About the Role

Key Responsibilities

• Create and analyze reports under limited supervision using relational databases, MS Excel, and Tableau to support multiple departments.
• Evaluate the impact of reimbursement methodologies for medical claims using professional and facility models, including CMS-based methodologies such as RBRVS, DRG, ASC, etc., as well as per diem, percentage of charge, and capitation.
• Audit vendor and provider contracts and reimbursement policies to ensure correct payments are made and translate audit results into financial impacts.
• Identify cost-saving opportunities by optimizing reimbursement methodologies and configuration, automating processes, and identifying other efficiency potential.
• Collaborate with various departments to implement new programs and policies for claims savings and process improvement.
• Build and maintain regular reporting for government compliance.
• Develop and maintain pricing tools to support accurate adjudication of complex claims.
• Manage large audit and repricing projects, including facilitating work groups and presenting findings.
• Assist department staff with technical functions including manipulation and interpretation of large data sets.
• Conduct ad hoc analysis for departmental leadership.

Requirements

• Bachelor's degree required, master's degree preferred.
• Minimum of two (2) years of experience in the health insurance or healthcare provider industry.
• Strong statistical, analytical, and problem-solving skills.
• Two (2) years of experience using data analysis tools such as SAS, MS SQL, MS Access, decision support systems, or other business intelligence tools.
• Experience with healthcare billing and claims data.
• Advanced proficiency in MS Excel and other MS Office products.
• Ability to communicate effectively both verbally and in writing.
• Ability to work well under pressure and with shifting priorities.
• Maintain confidentiality and project a professional business image.

Nice to Have

• Experience with healthcare billing and claims data.
• Experience with decision support systems or other business intelligence tools.

Qualifications

• Bachelor's degree (required)
• Master's degree (preferred)
• Two (2) years of experience in healthcare or health insurance industry

Benefits & Perks

• Paid holidays
• Health insurance
• Dental insurance
• Flexible spending account
• Paid time off
• Employee assistance program
• Vision insurance
• 401(k) matching