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Configuration Data Quality Analyst

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POST DATE 9/1/2016
END DATE 11/5/2016

Capital District Physicians' Health Plan, Inc Albany, NY

Company
Capital District Physicians' Health Plan, Inc
Job Classification
Full Time
Company Ref #
77570198_1926
AJE Ref #
576050320
Location
Albany, NY
Experience
Mid-Career (2 - 15 years)
Job Type
Regular
Education
Bachelors Degree

JOB DESCRIPTION

APPLY
The Data QA Analyst is primarily responsible for the identification of claims that require adjustments due to retrospective configuration changes. This involves intensive claims analysis to determine proper application of benefits based on product selection as well as payment based on provider contract review. Throughout the process the Data QA Analyst is identifying potential issues, defects, process improvement opportunities and summarizing and reporting this information to the Configuration management team. This individual must have a strong understanding of claims processing, data profiling and analytical skills using tools such as MS Excel, MS Access, and Toad (SQL tool).

QUALIFICATIONS:

* Bachelor s degree required. 7 years relevant experience may be substituted for degree.

* Minimum of three (3) years configuration and/or claims processing or claims customer service experience with specialization in benefits, pricing, and provider configuration, meeting facilitation.

* Minimum of four (4) years experience in healthcare/insurance programs and processes and working with internal departments and external vendors is preferred.

* Understanding of all types of medical claims processing including, but not limited to, professional, facility, dental, HRA and FSA claims.

* Strong analytical skills required.

* Excellent organizational, planning, project management, problem solving and decision making skills including experience with project risk assessments required.

* Knowledge of healthcare and HMO processes, rules, regulations, enrollment/eligibility guidelines and reporting requirements for HMO, PPO, ASO, Medicare, Medicaid, Family Health Plus, and Child Health Plus.

* Ability to track, trend, and report useful data.

* Effective verbal and written communication & presentation skills are required. Must be able to communicate with technical and non-technical audiences.

* Excellent organizational, planning, problem solving and decision making skills including experience required.

* Demonstrated experience in data access and profiling using SQL and working knowledge of Microsoft Access, Word, and Excel is required.

* Ability to think creatively and outside of the box.

* Ability to understand Facets data model and Configuration of tables related to benefits, pricing, and provider data.

* Ability to determine how configuration data impacts claim adjudication.

* Ability to work independently as well as in a team setting is required.

* Able to work in fast paced and deadline-driven environment.

* Demonstrated ability to identify weaknesses in workflow and develop and implement process improvements to continually ensure that corporate goals are satisfied.

Salary Grade: 16

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant s race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.