Codoxo · 2 hours ago

Lead Business Analyst, Healthcare Claims & Data Validation

United States

Full-time

Remote

Mid Level

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Responsibilities

Possess a strong understanding of healthcare claims, provider, and member data.

Exhibit a strong knowledge and understanding of the various fields included on professional, facility, pharmacy, and dental claims data.

Demonstrate a solid understanding of relationships within healthcare claims data.

Demonstrate proficiency in medical codes, including ICD-10, CPT, HCPCS, DRG, etc.

Demonstrate expertise in both pre- and post-adjudicated claims data.

Understand claim adjustment logic and its application.

Play a crucial role in maintaining the data health of our platform.

Ensure the accuracy, consistency, and integrity of healthcare claims, provider, and member data.

Analyze data supplied by the customer to identify potential data gaps and nuances.

Assess data to ensure it aligns with defined standards and formats required by platform.

Validate claims data within our platform after ingestion to ensure accuracy and reliability.

Have previous experience working in a healthcare organization, understanding the complexities of the industry.

Have previous experience working with and analyzing healthcare claims data.

Utilize hands-on experience to create, maintain, map, and manage healthcare claim data effectively.

Maintain data mappings and update them to reflect changes in data or systems.

Assist with documenting data transformation rules to ensure accurate ingestion into the platform.

Identify and utilize external data sources to enrich healthcare claim data, enhancing its completeness and relevance.

Advanced knowledge of Microsoft Office Suite, including Excel and other Office 365 productivity tools.

SQL experience required. Python experience preferred.

Create customer-facing external reports based on data health insights to provide value to our clients.

Document identified data gaps and issues for internal consumption and communication to the customer.

Provide regular status updates to both internal and external stakeholders.

Clearly communicate data gaps and issues to customers.

Lead data discussions and provide subject matter expertise on potential solutions.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Healthcare Claims ExpertiseMedical Coding ICD-10Medical Coding CPTMedical Coding HCPCSData ManagementSQLMicrosoft ExcelData ValidationSaaS ApplicationsPython