Kelsey-Seybold

Sr. Data Operations Analyst

Location US-TX-Pearland
Posted Date 1 week ago(11/23/2021 9:41 AM)
Job ID
2021-26449
Category
Finance/Business Office

Overview

Kelsey-Seybold Clinic, a Houston tradition in patient-centered care, is a multispecialty clinic with over 25 locations and comprises more than 500 physicians providing primary and specialty care in a collaborative manner.

 

With 55 different clinical and non-clinical specialties, you can design a career path at Kelsey-Seybold Clinic that allows you to grow your future in a completely new direction.

 

Kelsey-Seybold Clinic is changing the way health cares. 

Responsibilities

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

Qualifications

Senior Data Operations Analyst

Location: Pearland Administative Office

Department: KS Plan Advantage - Health Care

Job Type: Full-time

 

 

 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 data
analysis, decision support, medical
economics, healthcare informatics,
or managed healthcare or
equivalent combination of
education and experience to
demonstrate ability to succeed in
data operations
• Demonstrated initiative and
problem-solving skills with ability to
convert raw data into actionable
business insights
• Demonstrated data extract and
transformation skills

 

B.

• Experience in the healthcare industry
with understanding of data in
healthcare organizations (including
claims data, ICD10, Medicare
Advantage, Health Insurance
Marketplace, capitated payment
models)
• Experience with ANSI 5010 837 data
specifications

Licenses

A.

 

B.

 

Special Skills

A.

• Advanced proficiency in Microsoft
Excel
• 3+ years’ experience with SQL or
other programming tools (including
Visual Basic and Excel macros)
• Experience writing, debugging and
documenting complex queries
against relational databases
• Basic knowledge of Microsoft
Power Point and Microsoft Word

B.

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

Other

A.

• Fluent in English both verbal and
written, effective communicator
• High level of accuracy with
excellent attention to detail
• Strong organizational and time
management skills
• Proven ability to work in a dynamic
setting and balance multiple
priorities while meeting deadlines
• Superior analytical skills
• Ability to communicate complex
information in a clear and concise
manner

B.

 

 

WORKING ENVIRONMENT

Clinical

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