Data Operations Analyst I

2 months ago

Houston, United States KS Management Services, LLC Full time

**Responsibilities**

The Healthcare Finance (HCF) department exists to monitor and improve the financial performance of Kelsey-Seybold's (KS) product lines and health plans. The HCF Analytics team is a customer service-focused department providing consultation to the KS executive team as well as to select operational and functional departments. The HCF Analytics team works closely with internal and external partners to identify revenue and cost savings opportunities, support new product and business development, ensure regulatory compliance, inform contract negotiations and complete reconciliation of incentive arrangements, claims, capitation, and premium payments with other payers, vendors and/or government entities. The HCF department is adequately staffed by highly skilled, motivated and inquisitive individuals that deliver complex analysis of financial and utilization data to support revenue enhancement and identify cost savings opportunities.

The Analyst will provide data, systems support, and analysis related to risk adjustment and quality data submissions. The team operates the CMS Encounter Data and HEDIS vendor software solutions and implements reporting and analysis specific to Medicare risk adjustment, RAPS, EDPS and HEDIS. The team analyzes and researches all encounter data errors and submission issues, collaborating with internal departments to work toward error resolution.

Key responsibilities of this position include:

- Encounter Data Analyst: Creating submissions and evaluating encounter data to identify errors created by operational, claims, and eligibility processes. Working with cross-functional teams to resolve errors and ensure completeness and accuracy of submissions.
- HEDIS/Quality Reporting Analyst: Mapping, verifying, and loading HEDIS data sources to calculate measure results and prepare member level detail to support audited reporting and quality improvement initiatives.
- System Support Analyst: Helping to develop and maintain the systems and processes that are the foundation of risk adjustment and quality data operations
- Report Writer: Developing, producing, and analyzing reports and data required to understand submission status and rejection issues related to risk adjustment and quality data submissions

**Job Title: Data Operations Analyst I**

**Location: Pearland Administrative Office**

**Department**:KS Plan Advantage-Risk Adjustm**

**Job Type: Full Time**

**Salary Range: $70,204 - $86,731 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)**

**Qualifications**

**Education**

Required:Bachelor’s Degree in Finance, Economics, Mathematics, Healthcare Administration, Computer

Science or related field

Preferred:N/A

**Experience**

Required: 0-3 years of experience in data analysis, decision support, medical economics, healthcare

informatics, or managed healthcare or equivalent combination of education and experience to demonstrate

ability to succeed in data operations

Demonstrated initiative and problem-solving skills with ability to convert raw data into actionable business

Insights.

Preferred: Experience in the healthcare industry with understanding of data in healthcare organizations

(including claims data, ICD10, Medicare Advantage, Health Insurance Marketplace, capitated payment models)

Experience with ANSI 5010 837 data specifications

Demonstrated data extract and transformation skills

**License(s)**

Required:N/A

Preferred:N/A

**Special Skills**

Required:Basic proficiency in Microsoft Excel

Basic knowledge of Microsoft Power Point and Microsoft Word

Preferred:Familiarity with EPIC and Clarity reporting data warehouse Knowledge of Crystal Reports, Microsoft

Access, or SSRS

Experience with SQL or other programming tools (including Visual Basic and Excel macros)

Experience writing, debugging and documenting complex queries against relational databases

**Other**

Required:Fluent in English both verbal and written, effective communicator

High level of accuracy with excellent attention to detail

Strong organizational and time management skills

Proven ability to work in a dynamic setting and balance multiple priorities while meeting deadlines

Superior analytical skills

Ability to communicate complex information in a clear and concise manner

Preferred: N/A

**Working Environment**:Office

**About Us**

Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by

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