Sr. Data Analyst, Claims Processing

Job Description

• Ensure accuracy and completeness of data submissions to EDGE • Provide reports and analysis specific to the ACA submissions to CMS • Identify root cause of data loss and rejections and co-ordinate with internal teams to enable complete and accurate submissions • Analyze, Identify and work with other teams to verify, test and correct errors • Create data mapping, workflows and process flows for ACA submissions processes • Monitor and track encounter data throughout the process and ensure data integrity through ongoing end-to-end reconciliation • Must be able to perform UAT and setup best practices for the function • Participate in cross-team ACA workgroup meetings • Analyze trends and create documentation supporting all reports • Track EDGE Server timelines for submissions and command runs to work with internal teams • Work closely with the Customer Success team to ensure that technical operations support client satisfaction and retention. • Lead the technical response to any client issues, driving quick resolutions and maintaining trust

Qualifications

• Minimum 5 years of healthcare Claims data management and EDI experience. • Minimum 5 years' experience working with ACA program • Knowledge of X12 EDI files, ICD10 codes, CPT/HCPCS, revenue codes and electronic claim submissions • In-depth knowledge and experience of SQL and any standard ETL tool • Ability to independently gather, interpret and analyze data • Ability to extract data from multiple sources using software tools • Ability to understand, interpret, create, execute complex queries and reports • Excellent written and verbal communication skills

Benefits

• Competitive salary • Medical, Dental and Vision benefits • 401k with Employer Match • Generous PTO plan