Job details
Job type full-time
Full job description
The business operations data analyst - healthcare eligibility solutions conducts a variety of data analysis in support of performant’s healthcare services operations teams for eligibility-related solutions that enable the business to operate efficiently and drive optimal customer and financial resultsThis position may also support new client implementations and existing programs with requirements gathering related to eligibility and client data.
Essential duties:
Leverage expertise in cob/tpl/msp and strong knowledge of healthcare eligibility and validation practices, claims, and medical terminology to review eligibility and client data.
Apply strong analytical skills to review and analyze eligibility and client data to identify trends, patterns and identify impact across various products.
Identify and research general changes and trends in the health insurance market
Assists operations team with review of identification and verification of eligibility data.
Assist technical and business leads with requirements gathering, documentation, and project management for new implementations and existing program changes.
Conducts a variety of data analysis for intelligent insights using subject matter knowledge, independent judgement, and analytical expertise.
Develops custom queries and reporting, conducts research, analyzes trends and activities, and presents data and findings based upon business needs and as need to identify opportunities, root causes of issues and to support business decisions and strategies.
Follows and complies with company, departmental and client program policies, processes, and procedures.
Responsible for utilizing resources to ensure compliance with client requirements, hipaa, as well as applicable federal or state regulations.
Successfully completes, retains, applies, and adheres to content in required training as assigned.
Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains clearances statuses as a condition of employment(note: client/government clearance requirements are not determined or decisioned by performant.)
Demonstrates performant core values in performance of job duties and all interactions.
Correct areas of deficiency and oversight received from quality reviews and/or management.
Perform other incidentals and related duties as required and assigned.
Note - all employees and contractors for performant financial may and/or will have access to sensitive, proprietary, confidential and/or public dataAs such, all employees and contractors will have ownership and responsibility to report any violations to the confidentiality and integrity of sensitive, proprietary, confidential and/or public data at all timesViolations to performant’s policy related to the confidentiality or integrity of data may be subject to disciplinary actions up to and including termination.
Required skills and knowledge:
Knowledge of and ability to work with large volumes of health care eligibility and claims data
Experience with medicaid / medicare / other tpl business models and products
General knowledge of requirements gathering, etl processing and data matching
Strong system skills with ability to quickly develop expertise in new systems and applications
Advanced skills in excel, access and/or other data analysis applications
Critical thinker with sharp problem-solving skills and analytical ability
Working knowledge of sql
General knowledge of x12 edi transactions, including, but not limited to 270/271, 834, 277, 837, 835
Professional verbal and written communication with good presentation skills
Able to work independently and meet deadlines with minimal supervision
Strong problem solving and communication (written and oral) skills
Ability to produce results and maintain positive attitude in fast paced, dynamic environment
Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail
Completion of teleworker agreement upon hire, and adherence to the agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with hipaa, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.
Physical requirements:
**note: must be able to meet requirements for and perform work assignments in accordance with company policies and expectations on a home remote basis (and must meet performant remote-worker requirements) until at which time staff will be notified and required to work from a performant office locationBasic office equipment required to perform remote work is provided by the company.
Performs duties in a busy standard office environment with moderate noise level or may work remotely from home-office as may be required based upon business needs, in accordance with company policies.
Reads and comprehends information in electronic (computer) or paper form (written/printed).
Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment.
Consistently viewing a computer screen, typing, using a keyboard and mouse.
Uses phone; headset can be provided.
Occasionally lift/carry/push/pull up to 10lbs.
Education and experience:
Bachelor’s degree in relevant field or equivalent combination of education and experience.
3+ years directly relevant professional experience working with healthcare eligibility or client data
Experience with data modeling and analysis
Knowledge and experience with healthcare, coordination of benefits, third party liability, and/or medicare secondary payer
Other requirements:
Must submit to and pass pre-hire background check, as well as additional checks throughout employment.
Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.
Must submit to and pass drug screen pre-employment (and throughout employment)Performant is a drug-free workplace.
Performant is a government contractorCertain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the company.
Visa sponsorship is not available.
Job profile is subject to change at any time.
Eeo - performant financial corporation is an equal opportunity employer.
Performant financial corporation is committed to creating a diverse environment and is proud to be an equal opportunity employerAll qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.
No agency submissions without performant authorized agency agreement and approved performant job order
