Claims Data Analyst - 208554

Position Title: Claims Data Analyst

Position Type: Contract to Hire

Duration: 6 months then Full time conversion

Compensation: $70,000 - $90,000

ABOUT OUR CLIENT / ABOUT THIS ROLE

Medix is currently seeking a Claims Data Analyst for a 6-month contract to hire role with one of our best healthcare clients!

Our client is a non-for-profit healthcare organization focused on managed care / managed long-term care plans and services in the Tri-state area. They are seeking a Claims Data Analyst to conduct claims adjudication, evaluate system coding, and generate analytical reports related to claims. Experience with SQL for querying and joining data is required, along with some basic dashboard reporting skills.

This role is available on a contract to hire basis, and on a fully remote basis within the EST or CST time zones

DAY TO DAY RESPONSIBILITIES FOR THIS CLAIMS DATA ANALYST WILL INCLUDE

• Identifying and calculating the monetary impact of claims processed incorrectly
• Developing utilization reports to audit and ensure accurate claims reimbursement
• Creating reports by using SELECT Statements and JOIN statements to join multiple table values together
• Working under the guidance of a Director of Claims
• Providing reports to vendors and providers, and conducting vendor oversight with plans of action as needed
• Working with the State Dept. of Health and with CMS in providing documentation for audits
• Manipulating claims data formats and output values as per individual reporting needs
• Conducting claims operations activities such as adjudicating claims, and managing over/under payments.
• Working with SQL statements on a daily basis in order to query claims systems, providers, authorizations and member data.

REQUIRED QUALIFICATIONS & TECHNICAL EXPERIENCE

• Strong knowledge of State and Federal Dept. of Health and CMS Medicare/Medicaid guidelines
• Required minimum 2-3 years experience in SQL
• Required minimum 3 years of experience working within the Managed Care (MCO) or Managed Long-Term Care (MLTC) industry
• Preferred exposure to Tableau, Power BI or Alteryx Dashboards
• Required minimum 2-3 years in Claims Operations / Claims Analysis

ADDITIONAL INFORMATION

This is a contract to hire position, expected to convert to a full-time employee ~ 6 months. Talent must be authorized to work for any employer in the US without the need for visa sponsorship now, or in the future. W2 only - please no third party agency or C2C Subcontracting inquiries.

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