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Sr. Data Analyst, Claims Processing

Reveleer

Reveleer

IT, Data Science
United States
Posted on Wednesday, July 3, 2024

Sr. Data Analyst, Claims Processing
Engineering Operations
Reveleer

Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.

Responsibilities:

  • Ensure accuracy and completeness of data submissions to EDGE
  • Provide reports and analysis specific to the ACA submissions to CMS
  • Identify root cause of data loss and rejections and co-ordinate with internal teams to enable complete and accurate submissions
  • Analyze, Identify and work with other teams to verify, test and correct errors
  • Create data mapping, workflows and process flows for ACA submissions processes
  • Monitor and track encounter data throughout the process and ensure data integrity through ongoing end-to-end reconciliation
  • Must be able to perform UAT and setup best practices for the function
  • Participate in cross-team ACA workgroup meetings
  • Analyze trends and create documentation supporting all reports
  • Track EDGE Server timelines for submissions and command runs to work with internal teams
  • Customer Success Partnership: Work closely with the Customer Success team to ensure that technical operations support client satisfaction and retention. Lead the technical response to any client issues, driving quick resolutions and maintaining trust

Qualifications:

  • Minimum 5 years of healthcare Claims data management and EDI experience.
  • Minimum 5 years' experience working with ACA program
  • Knowledge of X12 EDI files, ICD10 codes, CPT/HCPCS, revenue codes and electronic claim submissions
  • In-depth knowledge and experience of SQL and any standard ETL tool.
  • Ability to independently gather, interpret and analyze data
  • Ability to extract data from multiple sources using software tools
  • Ability to understand, interpret, create, execute complex queries and reports
  • Excellent written and verbal communication skills
  • Ability to extract data from multiple sources using software tools
  • Ability to understand, interpret, create, execute complex queries and reports
  • Excellent written and verbal communication skills

What You’ll Receive:

  • Competitive salary
  • Medical, Dental and Vision benefits
  • 401k with Employer Match
  • Generous PTO plan

SALARY RANGE: $125,000 - $150,000 / annually

Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.

Reveleer E-Verifies all new hires.

Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.