Healthcare Data Analyst

Location: Monterey Park, CA
Date Posted: 03-30-2018
Healthcare Data Analyst – Managed Care
Monterey Park, CA  (Eastern suburb of Los Angeles)
Data Analyst Job Summary:
  • Manage encounter inbound & outbound submissions/responses from/to all contracted medical groups, MSO, Hospitals, PBM, Vendors, Clearinghouses, and trading partners.
  • Provide the guidance & technical supports for onboarding and submissions.
  • Ensure inbound and outbound encounter data quality to be compliant with all company and regulatory standards
  • Create/manage Performance Report Cards for all inbound encounter submissions.
  • Create/manage all inbound & outbound  Dashboards, KPIs, SOPs, Self-Appraisal reports, Policies & Procedures to ensure and improve inbound & outbound encounter submissions performance.
  • Take the initiatives to develop the methodologies, encounter submission performance measures/programs, and strategies to identify the business and operation opportunities for inbound & outbound performance improvement.
  •  Ensure Encounter inbound, internal, and outbound processes to align with corporate and all regulatory agencies’ business requirements & needs.
  • Work with Healthcare Analytics and Encounter Systems teams to support the department goals and priorities.
Data Analyst Background:
  • Requires Bachelor’s degree in business, health care, data analytics, or related field; Master’s degree is highly desired.
  • At least 7 years of experience working in a managed care environment, preferably in a data analysis, operation management, and informatics position.
  • Ability to comprehend and work with HIPAA standard transaction sets, specifically 837P, 837I, 837D, NCPDP 4.2, 277, and 999
  • Around 7 years prior experience with State and Federal regulatory data standards and requirements.
  • Knowledge of healthcare management in Provider Network Operations, Member Enrollment, Claim Process,Medical Payment and Revenue Reporting, and Encounter submissions and measures.
  • Significant experience analyzing large volumes of data using PC-based software applications, including Microsoft Excel, including experience using SQL and Oracle to extract data from a data warehouse.
  • Understanding of how to measure and monitor service and quality metrics associated with managed care operations.
  • Proficient in Microsoft Office applications, with demonstrable skills in Access and Excel, and the ability to learn new and complex computer system applications.
#CNT or #Admin
Division Vice President - I.T.
CareNational Healthcare Services
480.681.0168 (CALL – TEXT – FAX)
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