Healthcare Financial, Inc. · 22 hours ago
Healthcare Claims Analytics Analyst
Quincy, MA, US
Full-time
Hybrid
Mid Level
$80K/yr - $110K/yr
3+ years expHealthcare Financial, Inc. is a recognized leader in improving healthcare outcomes, and they are seeking a Healthcare Claims Analytics Analyst to join their IT team. The analyst will be responsible for transforming complex healthcare datasets into actionable insights, ensuring data integrity, and collaborating across teams to enhance reporting accuracy.
Health Care
No H1B
Responsibilities
Responsible for data collection, preprocessing and exploratory analysis of complex health care datasets
Analyze incoming data from health plans to ensure accuracy and identify discrepancies or issues
Analyze and interpret healthcare claim data to support/recommend decision-making processes
Advanced SQL proficiency with experience writing complex queries, insightful reports, and dashboards against healthcare databases
Transform raw data into actionable insights that support strategic business decisions
Develop, maintain, and execute comprehensive QC checklists and validation frameworks to ensure data integrity
Create detailed mapping documentation, maintain data dictionaries, and establish standardized approaches for clinical data interpretation
Create, execute, and maintain ETL jobs and procedures to load, validate, and ensure the accuracy and integrity of healthcare claims and eligibility data
Translate data findings into clear, concise reports and presentations for stakeholders at all levels
Work with internal teams to enhance data processing workflows and reporting accuracy. Actively contribute innovative ideas and support ad hoc projects, including time-sensitive requests
Other duties as assigned
Qualification
Required
Bachelor's Degree in a relevant field such as Computer Science, Mathematics, Statistics, or Engineering. Equivalent experience may be considered
3-5 years of experience in a Managed Care/Healthcare/Medical Insurance Claims environment, alongside in-depth knowledge of Medicaid and Medicare guidelines
3-5 years of experience in business intelligence and analytics, particularly in a healthcare environment where complex data analysis and report/dashboard development are key responsibilities
Extensive experience with claims processing, medical terminology and coding systems
In-depth understanding of 835 Remittance, 837 Claim, and 834 Enrollment file formats, with proven ability to interpret, analyze, and troubleshoot EDI transaction sets for accuracy and compliance
Understanding of HIPAA, HITECH, and healthcare data governance requirements
Hands-on experience with one or more ETL tools, such as Pentaho or Alteryx, to build, execute, and support data pipelines
Hands-on experience in data cleaning, validation, and resolving generic problems across workflows and pipelines
Understand claim payment methodologies such as Medicare, Medicaid, and Commercial Reimbursement
Understanding of relational databases, data relationships and joins
Excellent technical proficiency in tools such as ProgreSQL, and SQL Coding. Adept at queries
Advanced SQL proficiency with experience writing complex queries, insightful reports and dashboards against healthcare databases
Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy
Proficiency in Microsoft Office Suite, including Excel and Word
Excellent written and verbal communication with ability to document complex mappings and present findings to varied audiences
Detail-oriented with the ability to work independently and as part of a team
Must possess a strong ability to understand business questions and translate them into analytical solutions
Demonstrated ability to troubleshoot complex data mapping issues and develop creative solutions for non-standard data formats
Benefits
Make a Difference: Help improve access to vital benefits and services for low-income and disabled individuals.
Collaborative Environment: Join a supportive, mission-driven team that values your ideas.
Professional Growth: Opportunities for learning and advancement.
Competitive Compensation: Salary and benefits that reflect your expertise.
Flexibility: Work remotely or in a hybrid model that fits your life.
Company
Healthcare Financial, Inc.
HFI helps connect low-income and disabled Medicaid health plan members with life changing Social Security disability income and benefits.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Kirk Reid
CEO Advisory Board
Joseph Ribaudo
Chief Financial Officer
Company data provided by crunchbase