Sr. Data Analyst, Provider Relations

Sr. Data Analyst, Provider Relations

New York, New York

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Summary

Responsible for financial reporting data review, analysis and issue resolution. Present reports and analysis of claims, financial reporting data and key performance metrics in support of joint and administrative operating committees. Review and analyze denied, pended and corrected claims for reconciliations and settlements. Analyze claim resubmissions to determine areas for provider education or system re-configuration. Partner with leadership to provide feedback on department workflows; and identify opportunities to create efficiencies in the process. Perform quality assurance on downstream reporting to ensure that systems are designed efficiently based on the Plan's business process. Reflect a full understanding of Emblem business practices, provider networks, reimbursement methodologies, and changes in NYS reimbursement methodologies. Identify outliers/targets through data mining. Manage, lead and resolve all IT/IS related projects and issues.

Responsibilities:

• Utilize PL/SQL and SAS to establish routines data extractions from enterprise data warehouse.
• Perform system and reporting upgrades, perform root cause analysis, on-going coordination with IT personnel and EH IT/IS for optimal performance of reporting.
• Provide analysis related to the identification of improved claim system configuration and call flows that would positively impact quality performance, reduce claim inventory and improve the customer experience.
• Provide operational and ad-hoc reporting and monitoring for key performance metrics to include enrollment, quality improvement, coding accuracy, cost containment (clinical metrics), claims and encounter submissions.
• Develop key performance indicators related to claim processing.
• Generate and distribute weekly/monthly/quarterly departmental reports to management and staff.
• Perform root cause analysis on key trends in data, including those that were not actively monitored, which may have an impact on departmental or provider group performance including timeliness of deliverables to key stakeholders, and the customer experience. Aggregate and interpret operational, claim data, and call center metrics to track, trend and identify opportunities for improvement.
• Responsible for conducting root cause analysis and working with staff in other business areas to assist with the resolution of complex Provider data issues and process improvement activities.
• Automate department procedures using Microsoft Access databases, Microsoft Excel spreadsheets, or other appropriate software (e.g., SQL, SAS).
• Extract and convert data according to contract and claims specifications.
• Responsible for creating data definitions, validating data, retrieving data from systems, merging data from multiple sources, participating or reviewing technical documentation, report configuration, and coordinates project efforts as directed to achieve desired results. Design and generate trend analysis reports.
• Identify aberrant patterns.
• Consolidate data from various reporting tools.
• Prepare estimates, plans and schedules for assigned projects.
• Devise computer programs, systems and related procedures; maintain and manage tracking systems.
• Prepare and provide data according to specifications in response to internal departmental requests.

Qualifications:

• Bachelor's degree in Computer Science or related field of study; Master's degree preferred
• 4 - 6+ years of relevant, professional work experience
• 3 - 5+ years of experience in data analysis
• Working knowledge of healthcare systems, metrics, statistics, etc.
• Proficient in analytical/reporting software: SAS, Tableau, SQL server, etc.
• Proficient in MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, etc.) with advanced Excel skills
• Knowledge of CPT, ICD-9, ICD-10 and HCPCS
• Experience with SQL and Client/server Applications
• Experience with data design: relational & dimensional data modeling knowledge
• Communication skills (verbal, written, presentation, interpersonal)

Additional Information

• Requisition ID: (see application details)
• Hiring Range: $75,000-$95,000