Telecommute Medical Claims Support Associate
3 weeks ago
HTML
HTML
Remote, United States
Surgical Care Affiliates
Healthcare Economics
Full-time
Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.
We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients.
We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.
We are seeking a candidate who is excited to take a thoughtful approach to examine and organize complex data for multiple physician specialty practices.
Moreover, we are seeking an analyst with an investigative mindset to explore nuances of the data and use data to drive decisions through report preparation and analysis.
This position will be remote.
Understand and become an expert on the structure and intricacies of incoming data sources. Communicate with team members and collaborators to understand unfamiliar/ambiguous data, as well as explore data thoroughly
Audit capitation report and review physician claims data to ensure the rates/payments are collected according to the health plan contracts
Interpret risk pool arrangements and summarize risk pool and incentive
Understand and analyze monthly capitation payments made to network providers; Support cross-functional team members with development, implementation, and maintenance of operational reports and analytical dashboards
Collaborate with specialty practice development leaders to evaluate potential physician group acquisitions, using a combination of external and internal claims data
Develop effective quality control processes to ensure data integrity
Assist in building the Managed Care budget for future years together with Payer Engagement contract negotiators
Retrieve, organize, and manipulate data from the Enterprise Data Warehouse and other databases to prepare data for reporting and analysis. Uphold and practice the principles and policies of the SCA Compliance program
Bachelor's degree in
Actuarial Science ,
or related field
Travel to health plan meetings, company meetings, center visits, etc. (Experience in hospital, health plan, risk-based care delivery organizations or physician claims analytics
Experience working with large healthcare claims data
related to medical claims/utilization data strongly preferred
Advanced experience in Excel required
MS SQL Server (Strong command over T-SQL) required
Tableau BI tool experience preferred
Experience with managed care contract terms analysis
Experience in physician compensation, billing, capitation, risk adjustment, CPT coding, and resource-based relative value scale (RBRVS)
Strong written and verbal communication skills including the ability to communicate results of data analysis to a variety of stakeholders
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