Claims Configuration Analyst

CommonSpirit Health; Camarillo (CA); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a detail-oriented data consultant to enhance information products and support strategic planning. This role involves analyzing complex data, improving business processes, and developing consultative relationships with clients. You will work within a flexible remote environment, focusing on data quality and insights to drive improvements in patient care management. Join a forward-thinking organization that prioritizes employee well-being with a comprehensive rewards package, including flexible health benefits and a generous retirement plan.

Benefits

Flexible Health Benefits

401k with Employer Match

Paid Time Off

Sick Leave

Qualifications

• 3-5 years of experience working with Excel and claims understanding.
• Healthcare background with knowledge of claim review and coding types.

Responsibilities

• Research and prepare complex data to document program activities.
• Analyze complex data for trends and provide actionable insights.

Skills

Data Analysis

Excel

Claims Understanding

Communication Skills

Education

Associate's Degree

Tools

QNXT

EZCAP

MS SQL

Job description

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that leverage economies of scale across provider types and geographies, and develop Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans, and employers, with a focus on coordinating patient care to contain costs while continually improving quality and service levels. We utilize industry-leading technology and integrated administrative systems supported by local human resources that prioritize patient care.

We offer an outstanding Total Rewards package that combines competitive pay with flexible, state-of-the-art Health & Welfare benefits, including medical, dental, vision plans, HSA, Life Insurance, and Long Term Disability. Our cafeteria-style benefits allow employees to choose options that suit their needs. Additionally, we provide a 401k retirement plan with a generous employer match, Paid Time Off, and Sick Leave.

Responsibilities

This position is remote, but will be expected to work 8AM-5PM PST business hours.

Position Summary:

Provides consultation on the design, testing, and enhancement of information products, including technical assistance and product development support to internal and external customers.

Responsibilities may include:

1. Researches, manipulates, and prepares complex data to document program activities and reports on results.
2. Provides oversight of data quality and offers feedback to improve auto adjudication rates and claim payment accuracy.
3. Develops consultative relationships with internal and external customers.
4. Performs ongoing research and support tasks for existing systems.
5. Leads or acts as a business technical expert in designing new applications or enhancements, including solutions integration.
6. Implements program-specific information through education, technology, and organizational methods.
7. Influences improvements to business processes and system infrastructure for better data quality, availability, and access.
8. Analyzes complex data for trends, provides in-depth interpretations, and conducts root cause analysis.
9. Translates complex data into actionable insights and makes recommendations.
10. Defines, develops, and implements information products to support strategic planning.

Qualifications

Minimum Qualifications:

• At least 3 years of experience reading and understanding claims.
• 3-5 years of experience working with Excel.
• 3-5 years of experience with QNXT.
• Associate's degree or equivalent experience required.
• Healthcare background.
• Working knowledge of claim review and coding types.
• Excellent verbal and written communication skills.

Preferred Qualifications:

• Previous experience with EZCAP is preferred.
• MS SQL experience is a plus.