Healthcare Data Analyst
USD36.06 - 38.47 / Hourly
Fort Lauderdale, FL
May 28, 2019
Data Analyst - Position Summary:
Provides data and informatics support and analyses including quality matrices, outcomes studies and program evaluations, internal and external reporting, monitoring data trends and identifying patterns, performing modeling, recommending improvement solutions.
Data Analyst - Essential Functions & Responsibilities:
• Detailed knowledge of health care claiming rules for both medical and pharmacy and familiarity with both the requirements for and data on health care claiming forms.
• An understanding of third-party adjudication process.
• Ability to independently research and interpret claiming regulations and rules at both Federal and local level.
• Ability to identify potential overpayment scenarios in the payment of medical and pharmacy claims. Individual will also design and conduct the data analyses required to support the identified overpayments.
• Monitor data trends, perform statistical analyses and prepare reports to facilitate Centers for Medicare and Medicaid Services (CMS) contract requirements.
• Experience in applying Correct Coding Initiative (CCI) or Outpatient Code Editor (OCE) or Medically Unlikely (MUE) edit a plus.
• Experience with manipulating and analyzing large datasets.
• Ability to prepare Medical Loss Ratio Reports for multiple contracts.
• Provide subject matter expertise on analyzing, vetting, and understanding healthcare data.
• Develop and deploy analysis methods for detecting healthcare waste, fraud, and abuse.
• Form and support robust opinions with imperfect data while still revising your beliefs in the face of compelling new data or analyses.
• Actively review and suggest improvements to current or planned systems and processes based on your knowledge of healthcare claims data.
• Collaborates with clients, development team and product management on a regular basis.
• Proficiency in at least one statistical analysis, scripting, or programming language (R, PHP, Java, Python, Matlab, SAS, etc.) or expertise in relevant tool (Excel, Business Objects, Access) required.
• SQL proficiency required.
• Well versed in healthcare compliance and HIPAA.
• HEDIS experience preferred.
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