Operations Reporting and Data Analyst
USA, Boston MA
$55,000 - $70,000
Job Description
This key role will be responsible for managing, tracking and analyzing operational metrics to drive process improvement throughout the Operations. The Operations Reporting and Performance Analyst is responsible for defining, managing, verifying, and reporting key quality KPIs/metrics for various aspects of the business. These Metrics will help drive business functions and identify key areas for process improvement. This position will coordinate data collection and reports of various operations function to ensure they are accurate and compliant with relevant law, regulations, process and procedures. Ideal candidates will maintain a broad knowledge of corporate OPL Claims Processing, Payment Integrity, Government Programs, regulations and regulatory guidelines for use in conducting Claims Inventory Management, Performance and Operational Improvement. Major focus on the role will include creation of data visualizations, reports, and dashboards for internal and external use.
Our Investment in You:
· Full-time remote work
· Competitive salaries
· Excellent benefits
Key Functions/Responsibilities:
· Review and manipulate data and reports from multiple sources.
· Design and maintain databases, data reports, and dashboards for tracking and reporting of quality.
· Develop functional and technical specifications for data extracts to be used for data analysis and reporting.
· Collaborate closely with SQL Programmers to interpret, define, and document data extraction specifications.
· Develop easy-to-understand charts, tables, and graph for diverse audiences.
· Monitor and quickly address OPL claims and data issues as they arise; escalate issues and support resolution in collaboration with the Manager of Other Party Liability.
· Incorporate quality improvement methods via all data dashboards and presentations
· Collaborate with other departments in order to interpret and assess needs of data requests.
· Ensure the quality and timeliness of assigned deliverables; manage multiple concurrent projects.
· Detail oriented with an understanding of quality improvement processes and related data skills
· Participate in the development and implementation of efficient and effective OPL methodology including test automation, processes, procedures, templates guidelines and tools.
· Determine root cause for data quality and make recommendations for long-term solutions.
· Develop and maintain quality assurance process and procedure documentation and job aids to ensure consistent findings and determinations
· Assist in developing project plans and costs, including personnel and fiscal requirements to achieve defined objectives.
Must have:
· Bachelor degree or higher
· Experience with Medicare and Medicaid
· Experience with data reporting and analytics
· SQL
· SAS
· EXCEL
Experience:
· Working knowledge of Healthcare Operations and Medicare and Medicaid Claims processing practices
· Other Party Liability claims and Claims Audit quality improvement concepts, practices and procedures
· Experience with data reporting and analytics
· 5+ years in an HMO or other managed care setting, with experience on Medicare products such as a Medicare Advantage Plan, SCO or Duals Plan a plus
· Project management
· Prior experience within an HMO, PPO or other health plan
· Prior experience within a Medicare Advantage, FFS, or other, organization and/or a Medicaid managed care organization
· Prior experience evaluating and managing vendor quality
Certification or Conditions of Employment:
· Pre-employment background check
· 2 doses of COVID vaccine
Competencies, Skills, and Attributes:
· Knowledge of Medicare regulations.
· Effective collaborative and proven process improvement skills. Helps to facilitate process improvement by engaging appropriate resources in issue identification and resolution.
· Demonstrated ability to successfully plan, organize and manage projects.
· Demonstrates strong organization skills and ability to work in a rapidly changing environment.
· Strong oral and written communication skills; ability to interact within all levels of the organization.
· A strong working knowledge of Microsoft Office products.
· Familiarity with government programs such as Medicare and/or Medicaid.
· Claims or other experience using industry standard coding.
· Experience applying analytical results to decision-making.
· Excellent team player with strong leadership skills.
· Must be able to effectively manage activities across multiple departments.
· Requires the capacity to clearly communicate complex issues and problems and escalate effectively.
· Detail oriented, excellent writing, proof reading and editing skills required.
· Ability to work independently and collaboratively, manage multiple projects and meet scheduled deadlines.
Working Conditions and Physical Effort:
· Regular and reliable attendance is an essential function of the position.
· Work is normally performed in a typical interior/office work environment.
· No or very limited physical effort required. No or very limited exposure to physical risk.
