Claims Data Analyst Position Available In Hillsborough, Florida

Claims Data Analyst 2.7 2.7 out of 5 stars Tampa, FL It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the CareNu Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing groundbreaking solutions for our clients’ unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success! Remote Role – must be located in the State of Florida with minimal travel to Tampa corporate office expected

Data Analytics Responsibilities:

Data Collection and Preparation:

Gather data from various sources (databases, APIs, etc.) and ensure its quality and accuracy.

Data Analysis:

Apply statistical methods and techniques to analyze data, identify trends, and uncover insights

Data Visualization:

Present findings using charts, graphs, and other visual tools to communicate insights effectively

Reporting and Communication:

Prepare reports and presentations to communicate findings to stakeholders

Problem Solving:

Identify and address data-related issues and challenges.

Data Modeling:

Develop and maintain data models to support analysis and reporting. Communicate effectively with providers, their liaisons, and medical staff leadership regarding any inquiries, responding in a timely manner Participate in department and organization meetings and provide feedback and suggestions to solve team, department, and organization issues and or concerns

Claims Processing and Verification Responsibilities:

Conduct thorough verification of healthcare claim submissions and data. Follow established internal policies and procedures related to claims. Conduct comprehensive analytics for all claims against regulatory requirements and contractual agreements. Guarantee secure handling and storage of confidential information. Review and process medical claims for accuracy, completeness, and compliance with insurance policies and regulations Verify patient data and medical information, requesting additional documentation as necessary Ensure proper coding and billing practices per Medicare requirements Identify and resolve discrepancies or errors in claims; analyze trends and recommend process improvements related to errors

Reimbursement and Payment Responsibilities:

Determine eligibility for reimbursement based on insurance policies and provider contracts Negotiate payments with insurance companies and providers Monitor claim status and ensuring timely payments

Communication and Customer Service Responsibilities:

Communicating with patients, providers, and insurance companies regarding claim status and resolution within the required timeframes Answering questions and addressing concerns with professionalism and empathy Provide excellent customer service and resolving issues effectively and efficiently

Other Duties:

Remain updated on changes in healthcare regulations and coding guidelines Conduct audits and quality assurance reviews Develop risk mitigation programs Perform other duties as assigned

Qualifications:

Associate’s degree in healthcare administration, business administration or related field required; Bachelor’s degree in related field preferred Minimum of ten (10) years of experience in Medicare Advantage Care claims processing setting Minimum of five (5) years of experience in Medicare Advantage Care claims analytics Proficiency in Structured Query Language for database management Ability to communicate effectively in English required; bilingual in English/Spanish preferred

Data Visualization Tools:

Familiarity with tools such as Tableau or Power BI.

Data Cleaning and Transformation:

Ability to clean, transform, and prepare data for analysis Proficient understanding of medical terminology Ability to analyze data, identify patterns, and draw conclusions. Familiar with electronic claims submissions and claim types Ability to pay close attention to data accuracy and quality.

Advanced Microsoft Office Suite Skills Compensation Pay Range:

$53,623.86 – $80,435.79 This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.