Data Analyst Sr, Finance - Encounter Data (Covered California)

University of California; Orange (CA); Hybrid; USD 84,000 - 135,000; Full time

Benefits offered by this job

Partial Telework

Competitive compensation

Comprehensive benefits package

CalPERS pension program

Job summary

CalOptima Health is seeking a Data Analyst Sr, Finance - Encounter Data (Covered California) to support data reporting for the Encounters team in Finance. You will maintain SQL tables, reconcile data for new projects, and coordinate with DHCS and CMS for submissions while improving data acquisition and reporting methods.

You’ll contribute to data integrity of claims and encounters, interact with IT and external vendors, and help shape data processing platforms for ongoing/new projects in a

Qualifications

• Bachelor’s degree in health care administration, business administration, mathematics or related field plus 5 years of data analyst experience creating and maintaining SQL queries and improving reporting.
• 3 years of Medi-Cal managed care or Medicare Advantage experience.
• Covered California (Commercial) experience.

Responsibilities

• Support the data reporting responsibilities of the Encounters team within the Finance department.
• Maintain SQL tables and ensure timely data submissions to DHCS and CMS.
• Collaborate with IT and vendors to improve data acquisition and reporting methods.
• Prepare and review analytics methods to verify data integrity of claims and 837 encounters.
• Create detailed business requirements for technical programs and new processing platforms.

Skills

SQL queries

Data analysis

Microsoft Excel

Communication

Problem-solving

Project management

Education

Bachelor’s degree in health care administration, business administration, mathematics or related field

Tools

Microsoft Office: Word, Outlook, Excel, PowerPoint

Job description

Join Us in this Amazing Opportunity

The Team You’ll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Data Analyst Sr, Finance - Encounter Data (Covered California)and help shape the future of healthcare where you’ll be an integral part of our FIN - Encountersteam, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to bePartial Telework.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Data Analyst Sr (Finance - Encounter Data) will support the data reporting responsibilities of the Encounters team within the Finance department. You will support with the maintenance of current Encounter tasks, such as monitoring and reviewing the 5010 837 files submissions. You will create and maintain Standard Query Language (SQL) queries to reconcile data for new projects, including submission testing with vendors for the outbound process with the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) and to continually improve data acquisition and reporting methods. You will ensure timely, complete and accurate data submissions inbound and outbound with the Information Technology (IT) team. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 90% - Data Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Supports the Encounter team with the maintenance of data through SQL tables.
  • Works with other departments to ensure complete and accurate data is being processed appropriately, which impacts DHCS and CMS, such as coordinating with Electronic Data Interchange (EDI) on any technical assistance for Encounter Data issues for 5010 837 data submissions.
  • Coordinates with Claims Administration and IT teams to work on improving encounter data submissions.
  • Assists with reconciling data in the SQL tables through the many processes of the Encounters Submission.
  • Provides expertise in data analysis, including members, providers, encounters and claims data.
  • Prepares and reviews analytics methods to verify data integrity of claims and inbound 837 encounters.
  • Creates detailed business requirements for technical programs, including implementation of new processing platforms for new and existing vendors.
  • Interacts with existing delegated health networks to establish and maintain strong working relationships.
  • Stays current on the DHCS, CMS and Covered California data reporting requirements and reports on any changes that affect CalOptima Health and/or health networks.
  • Refers complex data integrity issues to the manager for further evaluation and action as needed.
• 5% - Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor’s degree in health care administration, business administration, mathematics or related field PLUS 5 years of experience as a data analyst creating and maintaining SQL queries and improving reporting methods required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 3 years of experience in Medi-Cal managed care or Medicare Advantage required.
• Covered California (Commercial) experience required.

You’ll Stand Out More If You Possess the Following:

• 4 years of experience in an Independent Physician Association (IPA), hospital or health plan setting.
• 4 years of experience with managed health care programs.
• 1 year of experience with submissions to Covered California.

What the Regulatory Agencies Need You to Possess?

• N/A

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds.

Ways We Are Here For You

• You’ll enjoy competitive compensation for this role.
  • Our current hiring range is: Pay Grade:312 - $84,092 - $134,548 ($40.43 - $64.6865).
    • The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
• This position is approved for Partial Telework (If the position is Telework, it is eligible in California only)
• comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
  • A generous PTO program
  • A quality work life balance
  • Various wellness programs
  • Tuition Reimbursement
  • Professional development opportunities
  • Career development opportunities
  • Flexible scheduling
  • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit.

CalOptima Health wants to have qualified employees in every job position.

CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws.

CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at [phone] if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.