Operations Reporting and Data Analyst

Job Title: Operations Reporting and Data Analyst

Full Time+Benefits

Remote

Summary:

This key role will be responsible for managing, tracking and analyzing operational metrics to drive process improvement throughout the Operations. The Operations Reporting and Performance Analyst is responsible for defining, managing, verifying, and reporting key quality KPIs/metrics for various aspects of the business. These Metrics will help drive business functions and identify key areas for process improvement. This position will coordinate data collection and reports of various operations function to ensure they are accurate and compliant with relevant law, regulations, process and procedures. Ideal candidates will maintain a broad knowledge of corporate OPL Claims Processing, Payment Integrity, Government Programs, regulations and regulatory guidelines for use in conducting Claims Inventory Management, Performance and Operational Improvement. Major focus on the role will include creation of data visualizations, reports, and dashboards for internal and external use.

Our Investment in You:

Full-time remote work

Competitive salaries

Excellent benefits

Key Functions/Responsibilities:

Review and manipulate data and reports from multiple sources.

Design and maintain databases, data reports, and dashboards for tracking and reporting of quality.

Develop functional and technical specifications for data extracts to be used for data analysis and reporting.

Collaborate closely with SQL Programmers to interpret, define, and document data extraction specifications.

Develop easy-to-understand charts, tables, and graph for diverse audiences.

Monitor and quickly address OPL claims and data issues as they arise; escalate issues and support resolution in collaboration with the Manager of Other Party Liability.

Incorporate quality improvement methods via all data dashboards and presentations

Collaborate with other departments in order to interpret and assess needs of data requests.

Ensure the quality and timeliness of assigned deliverables; manage multiple concurrent projects.

Detail oriented with an understanding of quality improvement processes and related data skills

Participate in the development and implementation of efficient and effective OPL methodology including test automation, processes, procedures, templates guidelines and tools.

Determine root cause for data quality and make recommendations for long-term solutions.

Develop and maintain quality assurance process and procedure documentation and job aids to ensure consistent findings and determinations

Assist in developing project plans and costs, including personnel and fiscal requirements to achieve defined objectives.

Supervision Exercised:

None.

Supervision Received:

Manager of Other Party Liability

Qualifications:

Competency with MS Office and MS Windows

SQL

Education Required:

High School Diploma or GED required

Must have:

Bachelor degree or higher

Experience with Medicare and Medicaid

Experience with data reporting and analytics

SQL

SAS

EXCEL

Experience:

Working knowledge of Healthcare Operations and Medicare and Medicaid Claims processing practices

Other Party Liability claims and Claims Audit quality improvement concepts, practices and procedures

Experience with data reporting and analytics

Experience Preferred/Desirable:

5+ years in an HMO or other managed care setting, with experience on Medicare products such as a Medicare Advantage Plan, SCO or Duals Plan a plus

Project management

Prior experience within an HMO, PPO or other health plan

Prior experience within a Medicare Advantage, FFS, or other, organization and/or a Medicaid managed care organization

Prior experience evaluating and managing vendor quality

Certification or Conditions of Employment:

Pre-employment background check

2 doses of COVID vaccine

Competencies, Skills, and Attributes:

Knowledge of Medicare regulations.

Effective collaborative and proven process improvement skills. Helps to facilitate process improvement by engaging appropriate resources in issue identification and resolution.

Demonstrated ability to successfully plan, organize and manage projects.

Demonstrates strong organization skills and ability to work in a rapidly changing environment.

Strong oral and written communication skills; ability to interact within all levels of the organization.

A strong working knowledge of Microsoft Office products.

Familiarity with government programs such as Medicare and/or Medicaid.

Claims or other experience using industry standard coding.

Experience applying analytical results to decision-making.

Excellent team player with strong leadership skills.

Must be able to effectively manage activities across multiple departments.

Requires the capacity to clearly communicate complex issues and problems and escalate effectively.

Detail oriented, excellent writing, proof reading and editing skills required.

Ability to work independently and collaboratively, manage multiple projects and me