Job Description: Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function
Education/Experience:
Bachelor s degree in related field or equivalent experience. 24 years of business process or data analysis experience preferably in healthcare. Advanced knowledge of Microsoft Applications including Excel and Access preferred. Project management experience preferred.
Benefits and Payment Configuration
Compliance Coding/Prepay Compliance (Payment Integrity)
Bachelor s degree in related field or equivalent experience. 2 years of business process analysis preferably healthcare (i.e. documenting business process gathering requirements) or claims payment/analysis experience. Advanced knowledge of Microsoft Applications including Excel and Access preferred. Knowledge of managed care information systems and experience in benefits pricing contracting or claims preferred. Knowledge of provider reimbursement methodologies preferred. Previous structured testing experience preferred.
Encounters:
Bachelor s degree in related field or equivalent experience. 2 years of business process analysis (i.e. documenting business process gathering requirements) experience in healthcare industry or 1 years of managed care encounters experience. Advanced knowledge of Microsoft Applications including Excel and Access preferred. Knowledge of claims and/or encounter processing and data analysis experience preferred. Understanding of HIPAA transactions (i.e.) preferred. Knowledge of managed care information systems and experience in SQL scripting preferred.
Provider Data:
Bachelor s degree in related field or equivalent experience. 2 years of business process analysis (documenting business process gathering requirements) experience in healthcare industry and/or working in a data driven environment. Advanced knowledge of Microsoft Applications including Excel Project and Visio preferred. Knowledge of data migration software enhancement/planning and Agile preferred.
Member & Provider Solutions
Bachelor s degree in related field or equivalent experience. 2 years of business process analysis (i.e. documenting business process gathering requirements) experience in healthcare industry and/or customer service or enrollment functions. Advanced knowledge of Microsoft Applications including Excel and Visio preferred. Experience managing projects with a high reliance on technology. Knowledge of data integration software enhancements/planning and Agile preferred.
Additional Sills: