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Senior Data Operations Analyst

Company: Kelsey Seybold Clinic
Location: Pearland
Posted on: June 6, 2021

Job Description:

Overview

Senior Data Operations Analyst (HEDIS)

Location: Pearland Administative Office

Department: KS Plan Advantage - Health Care

Job Type: Full-time

COMPANY PROFILE

Kelsey-Seybold Clinic. Changing the way health cares.Kelsey-Seybold Clinic is Houston's premier multispecialty group practice, founded in 1949 by Dr. Mavis Kelsey. With more than 21 clinic locations and more than 400 physicians, Kelsey-Seybold provides medical care in 55 medical specialties and is home to a nationally accredited Breast Diagnostic Center, Endoscopy Center, Infusion Center and Cancer Center. Our mission is to provide our team members with exceptional opportunities for professional and personal growth..

JOB SUMMARY

The Healthcare Finance (HCF) department exists to monitor and improve the financial performance of Kelsey-Seybold's (KS) product lines and health plans. The HCF Analytics team is a customer service-focused department providing consultation to the KS executive team as well as to select operational and functional departments. The HCF Analytics team works closely with internal and external partners to identify revenue and cost savings opportunities, support new product and business development, ensure regulatory compliance, inform contract negotiations and complete reconciliation of incentive arrangements, claims, capitation, and premium payments with other payers, vendors and/or government entities. The HCF department is adequately staffed by highly skilled, motivated and inquisitive individuals that deliver complex analysis of financial and utilization data to support revenue enhancement and identify cost savings opportunities.The Senior Analyst will provide data, systems support, and analysis related to risk adjustment and quality data submissions. The team operates the CMS Encounter Data and HEDIS vendor software solutions and implements reporting and analysis specific to Medicare risk adjustment, RAPS, EDPS and HEDIS. The team analyzes and researches all encounter data errors and submission issues, collaborating with internal departments to work toward error resolution. The Senior Analyst is able to independently identify areas requiring investigation, define and perform analyses, and recommend solutions with little to no guidance.

Key responsibilities of this position include: Encounter Data Analyst: Creating submissions and evaluating encounter data to identify errors created by operational, claims, and eligibility processes. Working with cross-functional teams to resolve errors and ensure completeness and accuracy of submissions. HEDIS/Quality Reporting Analyst: Mapping, verifying, and loading HEDIS data sources to calculate measure results and prepare member level detail to support audited reporting and quality improvement initiatives. System Support Analyst: Helping to develop and maintain the systems and processes that are the foundation of risk adjustment and quality data operations Report Writer: Developing, producing, and analyzing reports and data required to understand submission status and rejection issues related to risk adjustment and quality data submissions Acting as a subject matter and technical expert for more junior analysts.

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)

Education

A.

Bachelor's Degree in Finance, Economics,Mathematics, Healthcare Administration,Computer Science or related field

B.

Experience

A.

5+years of experience in dataanalysis, decision support, medicaleconomics, healthcare informatics,or managed healthcare orequivalent combination ofeducation and experience todemonstrate ability to succeed indata operations Demonstrated initiative andproblem-solving skills with ability toconvert raw data into actionablebusiness insights Demonstrated data extract andtransformation skills

B.

  • Experience in the healthcare industrywith understanding of data inhealthcare organizations (includingclaims data, ICD10, MedicareAdvantage, Health InsuranceMarketplace, capitated paymentmodels) Experience with ANSI 5010 837 dataspecifications

Licenses

A.

B.

Special Skills

A.

  • Advanced proficiency in MicrosoftExcel 3+ years' experience with SQL orother programming tools (includingVisual Basic and Excel macros) Experience writing, debugging anddocumenting complex queriesagainst relational databases Basic knowledge of MicrosoftPower Point and Microsoft Word

B.

  • Familiarity with EPIC and Clarityreporting data warehouse Knowledge of Crystal Reports,Microsoft Access, or SSRS

Other

A.

  • Fluent in English both verbal andwritten, effective communicator High level of accuracy withexcellent attention to detail Strong organizational and timemanagement skills Proven ability to work in a dynamicsetting and balance multiplepriorities while meeting deadlines Superior analytical skills Ability to communicate complexinformation in a clear and concisemanner

B.

WORKING ENVIRONMENT

Clinical

Keywords: Kelsey Seybold Clinic, Pearland , Senior Data Operations Analyst, Other , Pearland, Texas

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