No sponsorship/transfer: must be GC or US Citizens.
Claims Data Specialist
- Knowledge of health system functions, terminology and standard coding systems required.
- Familiar with standard concepts, practices, and procedures of medical claims adjudication.
- Minimum of five years experience working with medical claims data. Experience with Medicare/Medicaid claims a plus.
- Superior data manipulation skills and ability to understand and interpret healthcare data.
- Ability to review raw claims, interprets custom adjudication handling for each client dataset, and develop custom load logic.
- Ability to comprehend complex technical and logical concepts and adapt quickly to changes.
- Strong quantitative, analytical, problem solving, organizational, communication and interpersonal skills are required.
- Attention to detail and maintaining high quality standards is a must.
- Create, modify, document, and enhance data specifications including identifying and mapping data elements from source system files into the relational table structure; translate requirements into technical specifications, validate that the data meets specified requirements
- Work with other departments so that a single version of business terminology is maintained within the existing data architecture.
- Work with business owners to define and document the scope and functional and technical requirements for data and reporting needs.
- Ability to function and contribute in a team environment.
- Bachelor's degree in Health Science, Health Informatics, Healthcare Management, Health Information Management, Business Information Systems, business or related field required
- 5+ years of strong Health Care Claims data analysis or Claims Adjudication Process experience in various Health Plans (Private, Regional, State Government, etc.) and good experience in T-SQL Programming.
- Strong analytical skills coupled with excellent interpersonal, administrative and oral/written communication skills.
- Technical writing and documentation skills are essential. Intermediate to Advanced skills with Microsoft Office tools (MS Word, Excel, PowerPoint, Visio. Project) necessary to document, track and present information related to the program/products supported.
- Ad-hoc SQL query skills highly desirable. Advanced knowledge of relational databases and ability to independently extract data using multiple tables, joins, and various complex data manipulation query logic statements
- Ability to define problems, collects data, establish facts and draw valid conclusions. Ability to perform systems analysis tasks including work process flow analysis, data flow analysis, and reporting.
- Ability to effectively present information and communicate findings, conclusions and recommendations to client and management. Able to respond effectively to managers, customers, peers and vendors.
- Experience in Health Insurance claims data and Health system function is a must.
- Must be authorized to work in the United States on a full-time basis for any employer