healthec

About HealthEC

HealthEC is a leading innovator and KLAS-recognized Population Health Management company dedicated to improving patient outcomes, managing costs and optimizing patient quality of life for the customers we serve. A comprehensive solution suite integrates all electronic patient data (any system, any setting of care, and in any format) and applies sophisticated analytics to identify provider-specific patterns and guide patient care interventions. HealthEC’s platform helps customers coordinate care and maximize incentive payments by identifying and managing high risk and chronically ill patients, and addressing gaps in care. Sophisticated care models simplify clinical workflow, engage patients in their care, and optimize performance to support quality measure reporting.

Job description

Location of this job is based out of Edison Office only

Acts as a subject matter expert:

  • In claims, eligibility and practice/provider rosters
  • To translate data dictionary / file formats into specifications
  • To provide data and business analysis expertise to developers and quality assurance personnel
  • Creates translation "mapping" documents / programming specifications from proprietary data dictionaries / file formats to system tables
  • Conducts analysis on claim, eligibility and provider files to determine anomalies in data and recommend system, operational or specification modification
  • Analyses of large amounts of data in data files and SQL tables to identify data patterns and issues
  • Performs high level quality assurance testing when appropriate
  • Devises or modifies specifications to solve complex problems surrounding data issues
  • Documents change requests, submit change request tickets, and monitor their progress, escalating delays as appropriate
  • Acts as the focal point for payer implementations: Monitor payer implementation project status and escalate delays or issues, as appropriate
  • Works as a liaison between the development/quality assurance team and the client/stakeholder
  • Conducts on-boarding and training of new implementation data analysts
  • Interfaces with Account Managers and clients, as required, at on-site meetings or telephonically to discuss the implementation cycle or to clearly present data analysis and discuss solutions
  • Creates Standard Operating Procedures if necessary

Knowledge, Skills, & Abilities:

  • Health insurance/Medicaid industry knowledge strongly preferred
  • Detailed understanding of claims and eligibility required
  • Understanding of claims data extraction preferred
  • Detailed understanding of data analysis and file structures
  • Understanding of database environments and how data is inter-related preferred
  • Must be detailed-oriented and possess strong organizational and multi-tasking skills
  • Ability to understand task requirements and work independently once tasks are assigned
  • Strong analytical and problem-solving skills required
  • Strong written and verbal communication skills required
  • Advanced Excel skills required
  • Basic SQL skills preferred

Education: College or higher education; Degree in Computer Science, Healthcare, Management Information Systems or related discipline preferred

Relevant Work Experience: 3-5 years’ in a claim’s role, and a minimum of 5 years’ experience in an analysis role required