Claims/Governance Analyst
4 weeks ago
Role: Claims Transaction data
Location: Remote
Hire Mode: Contract
Visa: No H1B, CPT, OPT
Top 3 Skills:
Deep understanding of Healthcare Payer Claims Transactions and Business Operations 5+ years of healthcare payer claims experience
Previous and deep interaction with healthcare Payer Claims Business Stakeholders
5+ years of Data Stewardship, enforcing operational Data Governance data policies, standards, and rules in real-time, across different data systems and sources. (Have dealt with handling variety, velocity, and volume of data via a flexible, dynamic, and scalable approach.
Role Summary
The Claims Transaction Data, Data Steward is a member of a cross-functional Data Governance team who partners with business, technical, and regulatory partners to ensure the documentation and implementation of Claims Transactions data standards. The Data Steward leads complex, cross-organizational conversations including risk assessment, data quality auditing, issue management, and knowledge management to ensure Claims Transaction data is fit for organization use. Candidates should have a strong data management background understanding how data is organized and relationships maintained between data domains across multiple enterprise system with a strong drive towards improving data quality and governance.
Responsibilities
Serves as Data Steward as part of an Agile team dedicated to Claims Transaction data operations & initiatives.
Leads Data Governance collaborations with Payer stakeholders to document, define, maintain, and manage Claims Transaction data standards and assets.
Assesses and monitors data quality metrics, analyzing trends and proactively promoting remediation and preventive action efforts.
Partners with IT and business teams to ensure the use of best practices and compliance with data standards.
Provides consultative stewardship services to delivery and issue resolution teams, serving as subject matter expert as needed.
Provides guidance on development, usage, and inventory of technical assets.
Represents GBS Data Governance in enterprise workgroups and data steward communities of practice.
Qualifications
Bachelor's degree or higher
5+ years professional work experience in:
o Data Stewardship, Data Governance, Data Management and Data Quality practices
o Healthcare Payer Claims Transactions and Revenue Cycle operations
o Claims Transaction data standards and operations, including:
Patient check-in and registration
Eligibility verification
Medical coding ICD-10, CPT, HCPCS, SNOMED CT - ASC X12N Implementation Guides
Claim submission
Claim processing
Claim payment
Claim reconciliation
Coordination of Benefits
Strong communications skills; written, verbal and presentation
Self-driven and able to function with minimal direction
Has the ability to engage business and data stakeholders to resolve questions or issues
Must have the ability to handle multiple and sometimes competing priorities in a fast-paced environment
Must be able to think creatively, innovate and flex where needed - quick/adaptive learner and collaborator/team player
Must have strong analytical and problem-solving capabilities
Able to strategize across complex, cross-functional projects and initiatives
Experience in Agile Methodology and tools (e.g., Jira, Rally, etc.)
Intermediate to Advanced data analysis skills and tools (e.g., SQL, SAS, Python, Hadoop, Teradata, Snowflake, Tableau, Collibra, Infosphere, Alation, etc.)
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