Data Analyst with FACETS - Hybrid (Mason, Ohio)

Data Analyst with FACETS - Hybrid (Mason, Ohio) 

We are looking to hire a candidate with the skills sets mentioned and experience for one of our clients within the retail luxury goods and jewelry industry. This is a Hybrid role in Mason, Ohio. Work hours: 8AM to 5PM – 1 hour break (8 hours a day, 40 hours a week). Hybrid 2 days per week in Mason office.

*Candidates who are US Citizens, Green Card holders, GC EAD holders, or TN visa holders eligible to work on W2 highly preferred.

Position Summary:

Serve as a Data Analyst on the Business Configuration team, responsible for provider agreement, fee schedule and network data integrity initiatives. Provide subject matter expertise for agreement, fee schedule and network setup. Partner with EyeMed cross functional teams to ensure efficiency and accuracy of configuration requests.

Key Responsibilities:

• Writing SQL queries to extract data from the database, analysis of configuration data to identify clean-up activities.
• Ensure agreement configuration accuracy that may impact provider payment and member responsibility.
• Set up new Network and Agreement configurations into the Facets system.
• Validate agreement and network configuration utilizing claims testing, SQL queries and Excel to ensure the configuration properly adjudicates during claims processing, for member benefit, reimbursements and provider pay amounts.
• Perform and resolve network and agreement configuration questions/issues sent to the Business Configuration team without guidance.
• Maintain relationships with Account Managers and Provider teams to develop a cohesive cross functional, results driven working environment.
• Self-manage completion of work inventory within established quality and turnaround time guidelines.
• Coordinate and participate in cross-functional team activities for issue resolution.
• Recommend process and system enhancements to drive improvements.
• Support the management team with on-going training activities, misc. projects, resolving issues, and serving as a subject matter expert for all Configuration requests.

Required Experience/Skills/Education:

• Experience with health provider and network data elements.
• Experience with Facets in a managed care setting. MUST HAVE FACETS EXPERIENCE.
• Experience with Medicaid and/or Medicare programs and reporting.
• Superior communication, critical thinking, teamwork and project management skills.
• Experience with Claim adjudication and provider reimbursements.
• 3 years' experience in Operations in the Healthcare industry.
• At least 5 years of experience working within a core claims administration system.
• Experience understanding claim adjudication for member and provider reimbursements.
• Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration.
• Knowledge of Medicare and Medicaid programs.
• A minimum of 2 years' experience writing SQL queries and exporting data from database tables.
• Associate degree or equivalent experience required.
• Good analytical and problem-solving skills.
• Good communication and interpersonal skills.
• Ability to work independently or as a part of a team.
• Ability to manage multiple complex assignments at once.
• Bachelor's degree or equivalent work experience.

Other Job Specifications:

• Employment Type: W2 only. NO C2C, NO 1099.
• Contracting Period: 12 months contract, with potential extensions.
• Job Location: Hybrid Mason, Ohio.
• Work hours: 8AM to 5PM – 1 hour break (8 hours a day, 40 hours a week). Hybrid 2 days per week in Mason office.
• Contract Rate: $46/hr. on W2.
• Interview Process: Phone/Video/In-person Interviews.

Salary : $46