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Senior Healthcare Claims Data Analyst

Contexture
Denver, CO
  • Expired: over a month ago. Applications are no longer accepted.
Job Description


 

 SENIOR HEALTHCARE CLAIMS DATA ANALYST

 

Job Title:                                                      Senior Healthcare Claims Data Analyst

Job Code:                                                     SRHCDA

Reports To:                                                  Clinical Informaticist
Base Location:                                              AZ or CO

Work Status:                                               Virtual Office

Minimum Starting Monthly Range:       $7,075

Hiring Range (Monthly Pay):                   $7,075 - $ 8,250

Full-time / Part-time                                 Full-time 

Exempt / Non-Exempt                              Exempt

Risk Designation:                                       Extremely High

 

Summary
As part of the Data Analytics and Reporting team, the Senior Healthcare Claims Data Analyst will support research, analytics, and reporting development needs for Contexture in support of various customer needs. This position will oversee claims data accuracy and completeness across multiple claims and encounters datasets. You will work with multiple data sources and cross functional teams to better understand the completeness of integrated datasets in legacy data systems and new data platforms. You will work closely with our customers to understand customer usage models, identify test use cases, and support quality assurance by performing client data checks to validate key learnings regarding healthcare claims data.

 

This position is based in Phoenix Arizona or Denver Colorado. Our strategic flexibility allows for remote work opportunities.

 

Essential Duties and Responsibilities include the following:

  • Create and produce monthly analytical reports for Contexture
  • Produce ad hoc analyses as requested by Contexture customers
  • Lead and support internal and external customers in data analysis activities, this includes measurement validation and in-depth analysis for publicly reported clinical quality measures and other measures for data and aggregation projects  
  • Maintain the health of claims and encounters datasets including data completeness and data accuracy
  • Perform data modeling and data wrangling duties on various data sets to find value and identify patterns
  • Drive novel analytical pathways to increase the usability and value of claims data solutions
  • Verify that expected inputs and outputs of combined claims datasets provide the correct results per the business requirements
  • Collaborate with internal and external project teams to identify any issues with technology solutions or customer claims data
  • Provide expertise and insight to internal users and members to optimize the use of claims data
  • Establish strong working relationships and active communication with key internal and external stakeholders to effectively manage expectations
  • Develop and maintain data models, data catalog and other data sets and coordinate with others on dependencies
  • Coordinate the capture, translation and transformation, and validation of all data required for internal and external measurement and reporting  
  • Conducts research and evaluation of data analysis, and data measurement methodologies utilizing technologies and tools that are strategically important for the organization and make recommendations for implementation and adoption internally and/or with external customers 
  • Centrally maintain a library of claims measures and specifications across all initiatives and claims data reporting projects
  • Prepare and present analysis and findings to key stakeholders 
  • Performs other related duties as assigned

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Skills

  • 5+ years’ experience working in a health plan or managed care environment with a focus on quality of claims, member, or provider data; decision support of performance management
  • Advanced Knowledge of industry coding (revenue codes, ICD classifications, CPT Codes, etc.) 
  • Experience working with and parsing through large disparate datasets required
  • Knowledge of Data Analytics/Data Warehousing/Big Data concepts preferred
  • Experience designing, implementing, and executing test cases and reporting metrics on data quality preferred
  • Strong understanding of project management disciplines such as Agile and Waterfall
  • Ability to understand and analyze, and understand healthcare financial and operational data and measures 
  • Demonstrated in-depth understanding of business requirements, data specifications and relational data sets required
  • Ability to translate documented business requirements into actionable tasks and execute those tasks 
  • Working knowledge of healthcare clinical codes sets such as LOINC, SNOMED, CPT, ICD, RxNorm, etc. 
  • Working knowledge of Electronic Data Interchange (EDI) ANSI X12 standards.
  • Working knowledge of medical claims data formats to include UB92, CCLS, 835, 834, CMS 1500 etc.
  • Ability to prioritize and manage multiple high priority tasks 
  • Ability to manage competing priorities in a complex and dynamic environment 
  • Ability to work in a fast-paced and rapidly changing environment and consistently meet strict service level agreement performance requirements
  • Ability to work independently as well as ability to effectively work in a team environment and maintain strong working relationships 
  • Advanced knowledge of Microsoft office toolset (Word, Project, Excel, and PowerPoint required, Visio preferred)

Education/Experience

Minimum of 5+ years of experience in claims data analysis and/or medical claims coding. Bachelor’s Degree with significant experience in Healthcare Business Administration or related field, Master’s Degree preferred. Formal certifications such as: CBCS, CCS, CMIS, NCCT, or Business Intelligence preferred. 

 

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually moderate. 

 

As a federal contractor, Contexture is subject to the requirements of U.S. Executive Order 14042. As such, Contexture is legally required to ensure that all employees are fully vaccinated for COVID-19 as a condition of employment, unless the employee is legally entitled to an accommodation. 

 

The position may  require occasional availability for after-hours work, outside of regularly scheduled hours.

 

The position may require ability to periodically drive to and from clients, conferences and / or events; and / or limited travel. 

 

This position is expected to be exposed to, process, or handle sensitive information including but not limited to Protected Health Information (PHI), Personally Identifiable Information (PII), financial information, etc. As such, the holder of this position is expected to comply with all applicable laws, regulations, organizational policies, and compliance expectations.

 

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The person in this position needs to frequently communicate and exchange information and move about inside the office to access file cabinets, office machinery, etc. Must be able to remain in a stationary position 50% of the time. Constantly operates a computer and other office productivity machinery, such as a keyboard, monitor, calculator, copy / scanner machine, and printer. Frequently moves office and work-related material weighing up to 10 pounds; Occasionally moves office and work-related material weighing up to 30 pounds. 

 

Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. 

 

Note:  This job description is not intended to be an exhaustive list of all duties, responsibilities and / or qualifications associated with the job. 

 

Benefits:   The organization provides a comprehensive benefits package. For details, please request a Benefit Summary from Human Resources. 

 

The organization is an inclusive Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or other status protected by law or regulation. 



Contexture

Address

Denver, CO
80246 USA

Industry

Technology

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