Opportunity Overview
We are seeking a highly analytical, detail‑oriented, and results‑driven Data Analyst to join our dynamic Payment Integrity team. This role is critical in transforming complex healthcare claims, provider, operational, and financial data into actionable insights that improve business performance, optimize audit outcomes, and drive operational excellence.
What You’ll Do
- Analyze large healthcare datasets including medical claims, audit outcomes, provider data, reimbursements, appeals, invoices, outreach activity, and operational performance metrics to identify trends, anomalies, and business opportunities.
- Build analytics to support provider outreach effectiveness, response tracking, follow‑up performance, and provider abrasion control initiatives.
- Monitor and improve end‑to‑end audit lifecycle SLAs, turnaround time (TAT), queue aging, throughput, and productivity metrics.
- Perform invoice reconciliation by validating recoveries, fees, payments, billing outputs, and financial reporting accuracy.
- Build and maintain dashboards, scorecards, and KPI reporting using Power BI, Tableau, Looker, or similar tools.
- Develop automated daily, weekly, and monthly reports for operational, financial, and executive stakeholders.
- Generate ad hoc reports and business analysis based on evolving operational priorities.
- Ensure all reports, dashboards, and published metrics are accurate, reconciled, and aligned across systems.
- Create profiling reports for auditors, providers, clients, claims inventory, productivity, and recoveries; continuously monitor for changes, trends, and performance drift.
- Detect operational drift, unusual patterns, leakage points, and inefficiencies; recommend corrective actions to improve overall process efficiency.
- Uncover hidden patterns in data and connect insights across multiple sources to support business decisions.
- Perform root cause analysis on missed recoveries, SLA breaches, provider abrasion, operational delays, and reporting variances.
- Use advanced analytics and forecasting to support staffing models, productivity planning, and business growth initiatives.
- Create and optimize complex queries, data models, and automated workflows using SQL and Python.
- Partner closely with operations, audit, finance, product, and leadership teams to support strategic decision‑making through analytics and reporting.
- Maintain data governance standards and adhere to HIPAA and company privacy policies.
Required Qualifications
- 2+ years of experience in Data Analytics, Business Intelligence, preferably healthcare claims analytics or payment integrity analytics.
- Advanced expertise in SQL, including complex joins, CTEs, stored procedures, optimization, and large‑dataset handling.
- Strong hands‑on expertise in Python for automation, reporting workflows, data transformation, and advanced analytics.
- Advanced proficiency in Microsoft Excel and Google Sheets, including pivots, lookups, formulas, data validation, and dashboards.
- Experience with BI/reporting tools such as Power BI and Tableau.
- Proven ability to ensure reporting accuracy, reconcile numbers, and maintain trust in published metrics.
- Strong analytical mindset with the ability to uncover patterns in data and connect the dots across multiple sources.
- High attention to detail with a strong focus on data quality and accuracy.
- Experience creating automated reporting suites, KPI dashboards, and executive scorecards.
- Experience monitoring productivity, SLA, TAT, queue health, financial metrics, and operational performance.
- Strong cross‑functional collaboration skills and ability to work with operations, audit, finance, product, and leadership teams.
- Excellent communication skills with the ability to translate complex findings into clear business recommendations.
- Strong prioritization, ownership mindset, and problem‑solving capability.
- Bachelor’s degree in Analytics, Statistics, Computer Science, Finance, Healthcare Administration, or related field.
Nice to Haves
- Knowledge of AWS services like Lambda, S3, EC2, and Textract.
- Strong experience in payment integrity operations, healthcare claims data, provider analytics, audit workflows, and financial reporting.
- Intellectual curiosity to learn new things.
- Familiarity with version control tools such as Git.
- Experience using Jira for tracking requests, sprint planning, and workflow management.
Location
Hyderabad (Nacharam), Telangana: Preferably able to commute or plan to relocate before starting work.
Equal Opportunity Statement
Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal.