Health Data Analyst

  • IT
  • Fort Lauderdale, FL / Hybrid
  • 1 year ago
  • 2 available

Job Description

Provides data & 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.

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.
  • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to maintain reasonably regular, punctual attendance consistent with the ADA, FMLA, other federal, state, and local standards, and company attendance policies and procedures.
  • Ability to come to work and work the regular schedule and shift for the position.
  • Compliance with all personnel policies and procedures.
  • Perform additional duties and related essential duties as assigned.

Required Education and Experience

  • Bachelors or Masters degree in related field
  • Three (3) years of experience with analyzing healthcare data – this experience should include work in at least 2 of the following areas:
  • Fee-for-Service claims analysis
  • Encounter claims analysis
  • Enrollment
  • Medicare crossover claims
  • MCO, federal, or other state Medicaid data
  • HEDIS Rate Calculation/Score Improvement
  • Testifying to, vetting, or certifying data analyses for use in litigation or policymaking
  • 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. SQL Server Standard 2014.
  • Well versed in healthcare compliance and HIPAA
  • HEDIS Experience Preferred
  • Expert knowledge of state and federal laws and regulations pertaining to Medicaid
  • Demonstrated communication and presentation skills
  • Applicant may be subject to a government security clearance investigation
  • At least two years prior experience in health care claiming field, either with a provider of medical or pharmacy services or at a payer for health care claims, including a state Medicaid Management Information System (MMIS) or as a consultant to either providers or payers.
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Date Posted:

Dec 14, 2022


Fort Lauderdale, FL / Hybrid

Job Title

Health Data Analyst




40h / week

  • Primary industry: Healthcare
  • Company size: 250 - 300
  • Founded in: 1999
  • Phone: 1-800-595-9631
  • Headquarter: Fort Lauderdale, FL
  • Social Media: