CareCentrix

  • Analyst - Claims Support

    Job Locations US-FL-Tampa
    Job ID
    2018-6386
    Category
    Claims Support Team
  • Overview

    The Claims Support Analyst supports Revenue Cycle Management and performs operational management functions (e.g. monitoring end-to-end inventories and assisting in resource allocations decisions across the department and vendor resources), metric development and tracking, business performance analysis and reporting, and business improvement projects. Responds to ad hoc requests for support and analysis. Requires limited supervision and technical assistance. Administer workforce levels in a manner to exceed key performance indicators and budgetary constraints within the department. Specialize in metric development, including the development of tools and reports to explain variation and inter-relationships across all business processes.

     

    Responsibilities

    • Works closely with management to gather, analyze, summarize and prepare recommendations of financial plans, trends, and operating forecasts.
    • Integrates multiple data sets from various systems to produce meaningful reports.
    • Develop and maintain systems to allow for efficient analysis and distribution of information, particularly through standardized regular reports.
    • Resolves complex organization and technological problems.
    • Ability to monitor and track highly detailed and multiple complex projects, systems, and data
    • Develop and manage reports on multiple key performance indicators and metrics across Revenue Cycle Management for all work types and other existing and new metrics.
    • Responsible for identification of process inter-relationships to provide deeper insight to management on business drivers behind the metrics.
    • Responsible for operation of the work distribution methodologies/ tools, current and future.
    • Administrate operational analysis, identifying and implementing processes as necessary to improve the level of quality and efficiency within Operations areas.
    • Serve as SME regarding the process flow of the life of a claim including understanding systems used and functions performed within each work type, dependencies/ interactions and identification of potential impact resulting from any change.
    • Problems solve for complex operational processes and research determining root cause of metric variances.
    • Develop, monitor and maintain work flow management reports and tools for all claims processes to support data analysis and reporting.
    • Problems solve for complex operational processes and research determining root cause of metric variances.
    • Perform on-demand, rapid analytics and reporting of multiple inputs/ sources.
    • Develop and manage data and/or databases that support performance improvement activities.
    • Develop and maintain comprehensive reports for management and analyze historical data for root cause research and trend.

    For Provider Claims Advocate:
    • Analyze trends in denials and rejections by mining data in Tableau and other reports to identify denial and rejection abnormalities.
    • Prepare ad hoc and regularly scheduled reports on current, quarterly, and YTD denials/rejects for the leadership and dedicated providers.
    • Data-driven, analytical with strong problem solving skills
    • Excellent communication skills; both verbally and written
    • Strong focus on process improvement and quality
    • Required technical skillset(s): Excel, SQL experience preferred
    • Proficiency in Tableau, Visio, and PowerPoint preferred
    • Ability to collaborate and form partnerships with colleagues
    • Ability to multi-task and manage concurrent projects in various stages

     

    TRAVEL REQUIRED
    10%

     

    Qualifications

    Bachelor’s Degree preferred, plus a minimum of 3 years of experience, preferably in healthcare operations. Excellent organizational and analytical skills required. Experience with working independently as well as in a team environment. Proficient in Microsoft Office applications, specifically Microsoft Excel, Visio, Word and PowerPoint. Ability to work under tight deadlines. Ideal candidate will possess expertise in data analysis, data collection and process improvement. Basic knowledge of TOAD, SQL and operating systems related to Revenue Cycle Management preferred. Medical terminology ICD-10 knowledge a plus.

     

    CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.

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