Job Summary:
Responsible for producing reports from various sources to provide the department /division with actionable information or business intelligence. Working with marginal oversight, the incumbent is responsible for performing complex research, analysis, and reporting of network utilization, cost containment and key operational information. This is a senior level position.
Responsibilities:
路Evaluate data and report findings for accuracy, completeness, intent, and scope, etc.
路Determine or agree upon deliverables with customer, as well as determining the resources necessary to meet those deliverables
路Act as liaison with IT /vendor and customer and initiate /implement project plan for requests
路Perform appropriate analysis on data: forecasting, modeling, regression
路Mine data from appropriate system and perform appropriate analysis on data
路Present data and provide feedback to client/customer; making recommendations where appropriate
路Provides guidance and day-to-day oversight of reconciliation functions to support Monthly Membership Reports, Medicare Secondary Payer and Coordination of Benefits
路Challenge the status quo and propose improvements in processes for higher efficiency and effectiveness
路Accountable for the financial reconciliation and vendor reconciliations for assigned lines of business
路Establish, monitor, and enforce reconciliation policies and procedures and internal controls
路Accountable for researching existing and new legislative changes in federal and statutory requirements
路Develop relationships with subject matter experts (SME)
路Seek and adopt best practices in data reporting
路Perform other relevant tasks as assigned by management
Education/Experience:
路Bachelor degree or equivalent years of work experience is required
路Minimum of five (5) years of business operations or similar experience is required, preferably in a health care environment
路Looking for someone with NJ Medicaid exp, claims processing exp and data exp.
路This is not a heavy data position.SQL exp is good, SAS would be a plus, but not required.
Knowledge:
路Prefer five (5) years data reporting experience
Strong PC skills
路Understanding interdependencies among data
Travel (If Applicable):
路Some travel may be required.
Integrated Resources INC
https://careers.smartrecruiters.com/IntegratedResourcesINC