Job description

Role: Operations Reporting and Data Analyst

Location: Remote

Type: FTE/Permanent

Must-Haves

1. Must have SQL/SAS experience

2. Other Party Liability (OPL) claims and Claims Audit quality improvement concepts, practices and procedures

3. Experience with Medicare and Medicaid

4. Experience with data reporting and analytics

5. Bachelor’s degree or equivalent experience

Job Description

Job Summary:

This key role will be responsible for managing, tracking and analyzing operational metrics to drive process improvement throughout the Operations. The Operations Reporting and Performance Analyst is responsible for defining, managing, verifying, and reporting key quality KPIs/metrics for various aspects of the business. These Metrics will help drive business functions and identify key areas for process improvement. This position will coordinate data collection and reports of various operations function to ensure they are accurate and compliant with relevant law, regulations, process and procedures. Ideal candidates will maintain a broad knowledge of corporate OPL Claims Processing, Payment Integrity, Government Programs, regulations and regulatory guidelines for use in conducting Claims Inventory Management, Performance and Operational Improvement. Major focus on the role will include creation of data visualizations, reports, and dashboards for internal and external use.

Key Functions/Responsibilities:

· Review and manipulate data and reports from multiple sources.

· Design and maintain databases, data reports, and dashboards for tracking and reporting of quality.

· Develop functional and technical specifications for data extracts to be used for data analysis and reporting.

· Collaborate closely with SQL Programmers to interpret, define, and document data extraction specifications.

· Develop easy-to-understand charts, tables, and graph for diverse audiences.

· Monitor and quickly address OPL claims and data issues as they arise; escalate issues and support resolution in collaboration with the Manager of Other Party Liability.

· Incorporate quality improvement methods via all data dashboards and presentations

· Collaborate with other departments in order to interpret and assess needs of data requests.

· Ensure the quality and timeliness of assigned deliverables; manage multiple concurrent projects.

· Detail oriented with an understanding of quality improvement processes and related data skills

· Participate in the development and implementation of efficient and effective OPL methodology including test automation, processes, procedures, templates guidelines and tools.

· Determine root cause for data quality and make recommendations for long-term solutions.

· Develop and maintain quality assurance process and procedure documentation and job aids to ensure consistent findings and determinations

· Assist in developing project plans and costs, including personnel and fiscal requirements to achieve defined objectives.

Experience Preferred/Desirable:

5+ years in an HMO or other managed care setting, with experience on Medicare products such as a Medicare Advantage Plan, SCO or Duals Plan a plus

Project management

Prior experience within an HMO, PPO or other health plan

Prior experience within a Medicare Advantage, FFS, or other, organization and/or a Medicaid managed care organization

Prior experience evaluating and managing vendor quality

Job Type: Full-time

Pay: $69,568.00 - $88,989.00 per year

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Compensation package:

• Bonus pay

Experience level:

• 5 years

Schedule:

• 8 hour shift
• Day shift

Education:

• Bachelor's (Required)

Experience:

• SQL/SAS: 5 years (Required)
• medicaid and medicare: 5 years (Required)
• data reporting and analytics: 5 years (Required)
• Other Party Liability (OPL) claims and Claims Audit: 5 years (Required)

Work Location: Remote

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