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.
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
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)
Bachelor’s Degree in Finance, Economics,
5+years of experience in data
• Experience in the healthcare industry
• Advanced proficiency in Microsoft
• Familiarity with EPIC and Clarity
• Fluent in English both verbal and