Claims/Governance Analyst

4 weeks ago


Dallas, United States SmartIPlace Full time
Job DescriptionJob Description

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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