Job Description
Job Description
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is eligible for remote work; Candidates MUST reside in California.
What You Will Be Doing :
Under general supervision, responsible for conducting and documenting data claims analysis to identify miscoding trends, potential fraud, and other areas of opportunity .
Our Vision :
Continuously improve the health of our community.
Our Mission :
We provide healthcare value and advance wellness through community partnerships.
Essential Functions :
- Defines and assists others in defining data, analytic and reporting needs, and interpreting data validity and accuracy.
- Compiles and integrates data from relevant sources.
- Ensures data quality through validation.
- Analyzes, interprets and models data, providing notations of performance deviations and anomalies.
- Designs and presents conclusions using statistical tools, and in consumable formats such as charts and graphs.
- Creates, maintains and publishes periodic and ad hoc reports and other documents; arranges for distribution.
- Assists in identifying and developing appropriate performance measurement tools.
- Assists in preparing for internal and external audits, and in the preparation of recommendations, responses and reports.
What You Bring :
Knowledge, Skills, Abilities and Competencies
Strong knowledge of claims data structures and data warehousing.Strong knowledge of claims systems, metrics and policies.Strong knowledge of medical claims adjudication processes and procedures.Strong knowledge of data analysis and communication / reporting tools and techniques, with ability to perform analysis and resolve problems of moderate complexity and recognize and act on trends.Strong skills in data visualization and narrative tools and techniques, with ability to position data effectively for consumption and action.Strong skills in database manipulation, including the ability to write and run queries (SQL), and link tables.Strong skills in data identification, integration, validation, manipulation, interpretation and reporting.Strong oral and written communication skills with the ability to communicate professionally to diverse individuals inside and outside of HPSJ, effectively explain complex information, and conduct presentations.Basic knowledge of change management theory, with the ability to implement effectively.Interpersonal skills - interact effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.Ability to develop, implement and maintain processes, procedures and other guidelines.Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his / her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.Strong collaboration skills, including but not limited to the ability to create and foster a collaborative work environment, and organize people and resources to solve problems and identify opportunities.Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.Strong mathematics skills, including the ability to calculate ratios, perform simple algebra and statistical formulas.Intermediate skills in Windows, Outlook and PowerPoint.Advanced skills in Word and Excel, including the ability to create charts and graphs.Strong mathematics skills.Ability to handle confidential information with appropriate discretion.Ability to speak and be understood in English.Preferred
Knowledge of Medi-Cal, CMS, NCQA HEDIS / CAHPS as they relate to claims processing.Knowledge of health plan functions and interactions.Knowledge of medical terminology and coding.What You Have :
Education and Experience
Required
High school diploma or equivalentAt least two years performing medical claims or similar analysis; orEquivalent combination of education and experiencePreferred
Associate’s DegreeExperience as an analyst in a healthcare claims department or managed care environmentKnowledge of Medi-Cal Guidelines and billing practices and RBRVSBasic knowledge of CPT / ICD 9 and 10, and HCPCSLicenses, Certifications
None required.
What You Will Get : HPSJ Perks :
Competitive salaryRobust and affordable health / dental / vision with choices in providersGenerous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution planTwo flexible spending accounts (FSAs)Employer-Paid Term Life and AD&D InsuranceEmployer-Paid Disability InsuranceEmployer-Paid Life Assistance ProgramHealth AdvocacySupplemental medical, legal, identity theft protectionAccess to exclusive discount mallEducation and training reimbursement in addition to employer-paid elective learning courses.A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.A shorter commute – if you’re commuting from the Central Valley to the Bay Area.Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice : This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.
