Operations Data Analyst II
Operations Data Analyst II
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Job Description
Lets do great things together!
About Moda
Founded in Oregon in 1955 Moda is proud to be a company of real people committed to quality. Today like then were focused on building a better future for healthcare. That starts by offering outstanding coverage to our members compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Lets be better together.
Position Summary
The Operations Data Analyst II conducts analysis to support operations under the Claims department using medical and pharmacy claims provider membership and enrollment data. Functions include auditing and assessing contract performance policies and procedures building reports for audit teams supporting clinical editing operations and providing technical assistance and ad hoc analysis for various departments. Some tasks are routine while others evolve to meet organizational demand offering exciting opportunities to learn and create new processes. This position allows for creative freedom enabling the analyst to utilize their knowledge experience and ideas to enhance deliverables. This is a full-time WFH position.
Pay Range
$39.67 - $49.59 hourly (depending on experience)
*Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.
Please fill out an application on our company page linked below to be considered for this position.
Dental Vision Pharmacy Life & Disability
Required Skills Experience & Education:
- Bachelors degree required masters degree preferred.
- Minimum of two (2) years of experience in the health insurance or healthcare provider industry.
- Strong statistical analytical and problem-solving skills.
- Two (2) years of experience using data analysis tools such as SAS MS SQL MS Access decision support systems or other business intelligence tools.
- Experience with healthcare billing and claims data.
- Advanced proficiency in MS Excel and other MS Office products.
- Ability to communicate effectively both verbally and in writing.
- Ability to work well under pressure and with shifting priorities.
- Maintain confidentiality and project a professional business image.
Primary Functions:
- Create and analyze reports under limited supervision using relational databases MS Excel and Tableau to support multiple departments.
- Evaluate the impact of reimbursement methodologies for medical claims using professional and facility models. Methodologies include CMS based (RBRVS DRG ASC etc.) per diem percentage of charge capitation etc.
- Audit vendor and provider contracts and reimbursement policies to ensure correct payments are made and translate audit results into financial impacts.
- Identify cost-saving opportunities by optimizing reimbursement methodologies and configuration automating processes and identifying other efficiency potential.
- Collaborate with various departments to implement new programs and policies for claims savings and process improvement.
- Build and maintain regular reporting for government compliance.
- Develop and maintain pricing tools to support accurate adjudication of complex claims.
- Manage large audit and repricing projects including facilitating work groups and presenting findings.
- Assist department staff with technical functions including but not limited to the manipulation and interpretation of large data sets.
- Conduct ad hoc analysis for departmental leadership.
- Perform other duties as assigned.
Working Conditions & Contact with Others
- Office environment with extensive close PC and keyboard use constant sitting and frequent phone communication. Must be able to navigate multiple computer screens. A reliable high-speed hard-wired internet connection required to support remote or hybrid work. Must be comfortable being on camera for virtual training and meetings. Work in excess of standard workweek including evenings and occasional weekends to meet business need.
- Internally with Claims Configuration Customer Service SIU Data Science Compliance Account Services Medicaid and Provider Relations. Externally with vendors providers health professionals and physician offices IPA delegates rented networks hospitals and licensing board.
Together we can be more. We can be better.
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race religion color age sex sexual orientation national origin marital status disability veteran status or any other status protected by law. This is applicable to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absences compensation and training.
For more information regarding accommodations please direct your questions to Kristy Nehler & Danielle Baker via email.
Required Experience:
IC
Employment Type
Full-Time
