Job role and  key responsibilities

This role is to build and implement an effective end to end reporting for payment integrity which involves MIS reporting, BI reporting and dashboards for both internal and client. The position is responsible for data collation, data analytics, data reporting and utilizing some of the advanced BI tools.

Key Responsibilities:

·         Demonstrated exceptional active listening and communications skills

·         Works with internal and external department customers to define and document requirements to enrich reporting capabilities

·         Develops systematic reporting processes and procedures to ensure timely delivery of daily, weekly, monthly, annual and ad hoc reporting to management and clinical partners

·         Troubleshoots data integrity issues, analyzes data for completeness to meet business goals and trending

·         Produces dynamic analytic summaries and visualizations that convey complex analytic problems and solutions in a way that is accessible to non-technical customers

·         Serves as a resource to operational claims and clinical staff, answering questions and assisting with department informatics, reporting and trending, and workflow/operational issues

·         Escalates issues to department leadership for support and guidance

·         Assists in the development and testing of new reports and ongoing support of existing solutions, including defect identification and resolution

·         Collaborates with leadership to identify highest value analytics projects that support strategic business goals.

·         Develops project timelines, communicates with customers, and cascades top priority projects to team members to meet project deliverables and customer expectations

Required skills and qualification

Qualification

·         Bachelor?s degree in Computer Science, Statistics, Mathematics or related field

Required Skills and Experience:

·         1-3 years of experience in collecting, analyzing, and presenting US Healthcare data and recommendations to management

·         Development of end to end payment Integrity reports like Data Intake, Audit Selections, Findings, Appeals, Medical record Management, Audit Operations, Recovery Operations, Provider Correspondence and Forecasting & Invoicing

·         Experience working within a health plan, managed care organization, provider operated healthcare environment or third party administrator

·         Experience in SAS, Power BI, Tableau, Qlikview

·         Extensive knowledge of MS Office and related software applications, such as Word, PowerPoint, Excel, Project

·         Load and synthesize healthcare data from multiple sources

·         Implement and develop data concepts and monitor their impact

·         Design, program and standardize processes and reports

·         Familiar with program or payment integrity initiatives, especially claims data and supporting data, analytics and documentation around claims administration and adjudication

An ideal candidate should be:

·         Keep abreast of industry trends and opportunities and apply best practice to payment integrity

·         Ability to think analytically, apply analytical techniques and to provide in-depth analysis

·         Love collaborative environments that use agile methodologies to encourage creative design thinking and find innovative ways to develop with cutting edge technologies

·         Proven interpersonal skills while contributing to team effort by accomplishing related results as needed

·         Must be a team player and adaptable to a dynamic work environment