Chloen Systems Inc.
We are seeking a highly skilled and experienced Senior Healthcare Analyst to join our large scale Healthcare claims systems and processing team. As a Senior Analyst, you will be responsible for analyzing complex data sets, identifying trends, and providing valuable insights to drive strategic decision-making. This role requires strong technical skills, attention to detail, and the ability to effectively communicate findings to stakeholders. Specifically the position requires the candidate to be able to take various claims-based data requests and produce focused adjudication reports, often encompassing multiple facets of both prior and destination payer activity. Must be able to work with multiple individuals and obtain specifications to produce the final reports while understanding the the technical constraints of the current business process and timing. Attention to detail is necessary to ensure appropriate request delivery as well as efficiency due to the ad hoc nature of requests.
Duties:
- Collect and analyze data from various sources to identify patterns, trends, and insights
- Develop and maintain databases to ensure accurate and up-to-date information
- Use SQL and other data analysis tools to manipulate and extract data
- Conduct data mining and data management activities
- Collaborate with cross-functional teams to define business requirements and develop solutions
- Design and implement systems for data collection, storage, and reporting
- Create reports and visualizations to present findings in a clear and concise manner
- Stay up-to-date with industry trends and best practices in data analysis
Experience:
- Bachelor's degree in IT, Computer Science, or related field; Master's degree preferred
- Proven experience as a Senior Analyst or similar role
- Strong knowledge of SQL and experience working with databases
- 7-10 years experience reviewing and interpreting 3rd party adjudication of hospital institutional and professional HIPAA 837 claims for denial resolution or additional collections
- Required to know the 837 envelope/loop/segment format for identifying adjudication details from billing details
- Understands hospital revenue cycle and various billing release schedules
- Has working knowledge of the Claim Adjustment Reason Codes and corresponding Remit Advice Remark Codes
- Has experience calculating expected reimbursement from commercial, private, and various government payers
- Has experience with determining payer sequence for appropriate collections in a timely manner
- Has completed government payer Credit Balance reporting for audit
- Has knowledge of ICD10-CM and -PCS as well as CPTs, HCPCS, and DRGs (specifically MS-DRGs)
- Solid understanding of data collection, analysis, and reporting techniques
- Familiarity with medical terminology and healthcare industry standards
- Ability to design system architectures for data analysis and reporting purposes
- Preference given to candidates who come from the provider side of claims processing
Technical Qualifications
- Five plus years of MS SQL Server Transact SQL via Microsoft SQL Server Management Studio (SSMS).
Location
Preference is given to candidates who reside in the US Eastern Time Zone and/or who are or have worked in the US North East.
Benefits:
- Competitive contract rate based on experience
Job Type: Contract
Pay: $75,500.00 - $129,500.00 per year
Benefits:
Schedule:
- Monday to Friday
- Weekends as needed
Work setting:
Experience:
- Microsoft SQL Server: 5 years (Required)
License/Certification:
- MS SQL SSMS (Required)
- ICD10-CM, PCS, CPT's HCPCS, DRG's (Required)
Work Location: Remote