Contracts/Claims Data Analyst

Retrieve medical care data from claims, contracts and related systems and produce relevant reports and analysis.

 

Under direction of the Associate Vice President of Contracting, and the Contracts Analyst Manager,  perform the following functions using company financial, contracting and claims reporting database;

 

1.  Access in-house database system(s) and extract, review and perform analysis and updates of claims, provider contract, Pay for Performance and HEDIS data.

 

2.  Develop reports that reveal comparisons and/or benchmarks that meet thresholds.

 

3.  Present analysis to management for the purpose of decision-making.

 

Education:  Bachelor?s degree with a major in data/financial analysis and/or business or healthcare management preferred, or equivalent background, training and experience.

 

Knowledge/Experience:  At least four years experience in financial data reporting, analysis, systems development or financial systems/programs administration.  A minimum of two years experience working in a managed care or health care environment.  Direct experience in quality and/or outcome measure processes. Advance experience working with data programs; Excel spreadsheets.  Knowledge of claims processing and healthcare contracts, DOFRS, HEDIS and Pay-for-Performance strongly preferred.

 

1. Ability retrieve, compute and analyze financial, contract and claims data.

2. Ability to design reporting formats for analysis purposes.

3. Knowledge of HEDIS processes.

4. Working knowledge of ICD 9/CPT, MDC/DRG coding, medical terminology and indemnity benefits plans.

5. Knowledge of claims payment processes.

6. Knowledge of Pay for Performance health plan programs.

7. Strong communication skills, both verbal and written.

8. Self-motivated; possess strong quantitative and organizational skills.

9. Ability to meet multiple and sometimes competing deadlines.

10. Ability to look at challenges as opportunities.

11. Ability to demonstrate a cooperative attitude and behavior with colleagues and supervisors.