Client Experience - Sr. Data Analyst (EDI Compliance)

Tabula Rasa Health Care is looking a Senior Data Analyst to work with clients, business analysts and application developers to help turn disparate data sets into actionable insights. The Senior Data Analyst will be responsible for designing, developing, testing and implementing reports. This position requires that the analyst be have proven experience in claims adjudication applications/systems, data and system analysis, EDI compliance components, data availability and quality, have a strong understanding of the business requirements, and the creativity to develop workable solutions for a wide range of customers.Some travel could be required to customer sites and for trainings.
 

Primary Functions:

• Work closely with clients, product owners and other stakeholders to understand their information needs and develop technical solutions; liaison between clearing house and other Healthcare EDI partners

• Application administrator for Claims Adjudication System

• Oversee and troubleshoot EDI transaction monitoring and claim related issues

• Provide expert support for EDI compliance related issues, including but not limited to claims, clearinghouse data, demographic interfaces and all transaction code standards.

• Help build and maintain Bi-directional data models to support the infrastructure

• Write complex SQL and stored procedures for analyzing and reporting datasets

• Unit test reports to ensure the highest quality deliverable

• Develop procedures and technical documentation to enhance use of our systems; reporting and query capabilities to improve efficiency and accuracy; document deviations for client set-up

• Develop innovative approaches to manipulate data sets in a way that enables clients to see patterns and trends

• Support, troubleshoot and resolve issues, request and inquiries from end users; Monitor compliance with federal and state guideline addressing issues in a timely manner

• Maintain new code sets and fee schedules

Qualifications:

Education, Experience & Training:

• Bachelor’s degree in Computer Science, Bioinformatics or related field

• 6-8 years as a Data Analyst professional

• 5+ years’ experience with reporting tools

• 5+ years’ experience with relational databases (SQL Server, MySQL) to analyze and manage data

• Strong SQL skills and experience for programming/implementing projects in existing databases

• In depth knowledge of claims management, adjudication and pricing methods, required

• Proficiency with compliant HIPAA transaction/code set standards (820,834,835,837,P/I/D), processes and operations development is required

• Experience in designing and managing all EDI transactions

• Experience with self-service analytics tools and distributed processing a plus

• Experience working in a healthcare environment

Specific Skills:

• Extensive knowledge of HealthCare payment cycle and claims forms, financial and accounting concepts, and workflows

• Knowledge of Medicare and Medicaid claim rules and regulation, pricing and payment

• Familiarity with PACE, MLTC, or other capitated programs a plus

• Strong experience with PLEXIS or EZCap a plus

• High proficiency with SQL languages (MySQL, SQL Server, DB2)

• Excellent client-facing communication skills

• Working knowledge in Software Development Life Cycle

• Strong knowledge and use of Microsoft Office applications

Competencies:

• Strong analytical and problem-solving skills

• Overall competency in business and technology

• Excited & motivated to learn new technologies

• Ability to be flexible with frequent changes

• Ability to problem-solve and ability to follow through on tasks

• Identify and design solution strategies

• Sense of urgency to attend to client demands

• Responsive and prompt communication

• Customer-service oriented

• Excellent time management

• Excellent verbal and written communication skills

• Self-motivated, team player, highly organized

• Attention to detail and accuracy of facts and documentation

• Ability to manage multiple priorities and work independently

Expected Hours of Work:This is a full-time position with an expectation to work an average of 40 hours per week, and an ability to be available outside of normal business hours to meet customer expectations on an ad-hoc basis.

Normal business hours are between 8:00 a.m. to 5:00 p.m.
 

Travel:Some – to customer sites and for trainings
 

Supervisory Responsibility: None.
 

Environment:This job operates in a professional, dress for your day, office environment. This role routinely uses standard office equipment such as computers, phones, printers, and filing cabinets.
 

Physical Demands:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to travel; use hands to finger, handle or feel; and reach with hands and arms.