Medicare Data Analyst - Care 'N Care
Thanks for your interest in the Medicare Data Analyst - Care 'N Care position.
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Qualifications
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High School Diploma or equivalent (required) AND
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4 years additional Experience in lieu of a Bachelor's degree (required) AND
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9 years’ experience in a Healthcare Environment without a Bachelor's Degree (required) OR
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Bachelor's Degree in Healthcare, Marketing, Communications, Public Relations, Business or equivalent (required) AND
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5 years’ experience in a Healthcare Environment with a Bachelor's Degree (required) OR
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Master's Degree (preferred)
AND
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Knowledge and background of CMS (strongly preferred)
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Knowledge of Medicare/Medicare Advantage Plans and Processes (strongly preferred)
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2 years’ experience in Medicare Advantage programs (preferred)
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Strong knowledge of Microsoft Office (Excel, Word, PowerPoint) (strongly preferred)
Position Responsibilities SWHR Data Analyst will analyze and trend claims related data to identify inefficiencies and implement process improvement; provide guidance and support to all claims and operations personnel toward resolution of claim-related issues with an emphasis on root cause analysis and resolution of problems. Reviews on audit reports for targeted error-prone claims based on historical data and emerging trends. Develops reporting processes and procedures to ensure timely delivery of daily, weekly, monthly, annual and ad hoc reporting to management. Reviews and analyzes High Dollar Claims [HDOL - Pending Statuses] report. Analyze oversight claims transactions in accordance with plan provisions. Follows oversighted adjudicated claims from clearing house system based on covered benefits, insurance and provider contracts. Reviews CMS submission and return reports in order to analyze gaps for potential greater error rates. Supports reporting and analysis on all projects for claims initiatives. Recommends and implements new or modified reporting methods and procedures to improve report content and completeness of information. Assists in new implementation project(s) related to the claims department. Assist in training new team members. Performs other duties as assigned.
In addition to the required qualifications, a successful Data Analyst will:
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Have excellent problem solving, communication and organizational skills.
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Strong understanding of financial impact and operational data.
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Skilled with the ability to receive strategic direction and execute with minimal supervision.
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Demonstrated ability to develop clean, insightful, and easily digestible potential financial impact and claims data, and including dashboards.
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Demonstrated ability to work under tight deadlines in a dynamic, fast-paced environment.
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Demonstrated ability to work both autonomously and in a team environment.
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Ability to embrace change and show flexibility in assignments and the work environment.
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Maintains a strong intellectual curiosity and demonstrated ability to improve skills.
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Knowledge of key database, analytical, and data visualization tools, including (but not limited to) Tableau Desktop, Tableau Server, and FACETs.
Why Southwestern Health Resources
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.
Moving healthcare forward
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.
We invite you to learn more about us at www.southwesternhealth.org.
Let’s move healthcare forward – together.
Highlights:
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Combining the strengths of UT Southwestern Medical Center, Texas Health Resources and more than 2,500 community physicians, we offer the largest provider network in North Texas. SWHR covers approximately 700,000 patient members across 16 counties in North Texas.
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SWHR is the parent organization of Care N’ Care Insurance Co., a leading regional Medicare Advantage health plan organization that serves approximately 17,000 patients in North Texas.
Additional perks of being a SWHR Data Analyst
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Gain a sense of accomplishment by contributing in a teamwork environment
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Positively impact patients’ quality of life
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Receive excellent mentorship, comprehensive training and dedicated clinical leadership resources
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Enjoy opportunities for growth
Explore Southwestern Health Resources Careers for more information and to search all career opportunities.
Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org.