Fort Lauderdale, Florida
Healthcare Data Analyst Job Opening in Fort Lauderdale, Florida - Summary 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 Duties and Responsibilities include the following:
Detailed knowledge of health care claiming rules for both medical 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.
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:
Bachelors or Masters degree in related field
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 and HEDIS experience preferred
Testifying to, vetting, or certifying data analyses for use in litigation or policy making
Proficiency in at least one statistical analysis, scripting, or programming language (R, PHP, Java, Python, Matlab, SAS, SSIS, etc) or expertise in relevant tool (Excel, Business Objects, Access) required.
SQL proficiency required.
Well versed in healthcare compliance and HIPAA
Knowledge of State and Federal laws and regulations pertaining to Medicare and Medicaid programs
Demonstrated communication and presentation skills
Applicant may be subject to a government security clearance investigation
Ability to manage multiple projects simultaneously.
Detail oriented with excellent communication skills (oral presentations and written) and interpersonal skills.
Must be curious, passionate, skeptical, and determined to get to the core of difficult problems.
Self-starter, able to independently identify and complete critical tasks with minimal supervision, messy data, and dynamic goals
Computer Skills
Technical skills will include, but are not limited to: SQL, Excel, Access
Intermediate level of proficiency in Microsoft Office software application including Word, Excel, and PowerPoint
Health System One (HS1 Medical Management is an equal opportunity Employer.
Job Type: Full-time
Required education:
Bachelor's
Required experience:
SQL: 3 years
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