Lead Provider Reimbursement Analyst - Health Alliance Plan

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s degree in Business Administration, Economics, Health Care, Finance, Information Systems, Statistics or related field.
• Minimum of five (5) years progressive analytical experience in a healthcare or managed care/insurance related setting with specific exposure to provider contracting and reimbursement data and methodologies as well as case management, disease management, patient/member data
• Demonstrated experience with data interpretation, analysis, and reporting; clinical and financial data; predictive modeling and forecasting; key performance indicators as it relates to medical cost data.
• Demonstrated experience automating complex reporting processes and developing best practices and reporting standards.
• Extensive knowledge of advanced financial methods and modeling used in analyzing health care data and in data mining
• Excellent analytical, problem solving, verbal and written skills to communicate complex ideas.
• Excellent skills with ability to integrate and co relate information from different domains and subject areas.
• Minimum of three (3) years of experience in leading staff in projects or supervisory/management position preferred.
• Demonstrated project management experience in running corporate wide projects
• Knowledge of medical claims data and managed care membership data
• Knowledge of business intelligence applications, data, and tools
• Advanced technical skills, which includes, but is not limited to: MS Access and Excel, Alteryx, SQL, SAS and/or other statistical software.
• Knowledge of Medicare and Medicaid Reimbursement methodologies a plus.
• Intermediate to advanced Cognos Report Writer skills
• Ability to navigate HAP systems, including Oracle, Facets, and other similar software.