Business Intelligence Analyst

1 month ago

Alpharetta, United States Omni Inclusive Full time
Job Summary:

This role is responsible for developing, implementing, and validating utilization and cost models that characterize providers' claims submissions and treatment patterns. The successful candidate will also determine if dentists are meeting the terms of participation in provider networks throughout the Enterprise and gather and analyze data from Enterprise repositories for recruitment purposes.

Key Responsibilities:

  • Develop and implement utilization and cost models to characterize providers' claims submissions and treatment patterns.
  • Determine if dentists are meeting the terms of participation in provider networks throughout the Enterprise.
  • Gather and analyze data from Enterprise repositories for recruitment purposes.
  • Perform queries, maintain integrity of databases and repositories, and collect data for ad-hoc request reports and documentation.
  • Prepare compensation reports and actuarial requests for compensation comparisons and analysis for compensation review committee meetings.
  • Review and prepare reports, compile statistics, and analyze data regarding dentists requesting changes to their compensation.
  • Coordinate collection of internal data to facilitate investigation of irregularities by dentists, enrollees, or other external entities, and respond to inquiries from internal investigative requests from compliance or legal.
  • Assist with onsite investigations into cases of suspected fraud or misrepresentation involving providers, brokers, clients, or enrollees by collecting and providing necessary data and statistics.
  • Keep abreast of network infrastructure and leverage data sets needed to meet Enterprise business requirements.
  • Review profiling parameters for statistical validity and recommend adjustments.
  • Support Client Acceptance Testing of Enterprise-approved business applications and provide input to improve reliability and accuracy of data.
  • Troubleshoot and suggest improvements to systems and software applications.
  • Build, develop, and test applicability of new utilization models based on claims data from MetaVance and evaluate systems and develop processes to streamline procedures.
  • Serve as a technical resource to division employees and coordinate with all other Enterprise areas when applicable.

Requirements:

  • Bachelor's degree or equivalent education is preferred, but candidates with proven experience will not be excluded from consideration.
  • A minimum of 3 years' experience in business, data collection/coordination, and analysis in areas of investigation and/or claims review processing.
  • Detail-oriented with research, analytical, and problem-solving abilities.
  • Knowledge and application of English grammar, including composition, editing, proofreading, and strong verbal communication skills.
  • Strong organizational/time management and project management skills and multi-tasking abilities.
  • Basic knowledge of generally accepted accounting principles.
  • Strong mathematical skills and ability to perform complex statistical calculations.
  • Knowledge of health care industry issues is preferred.
  • Knowledge of Enterprise products, policies, claims, eligibility, and underwriting guidelines and procedures.
  • Knowledge of Enterprise systems, including Business Objects, MetaVance, AS400, and reporting tools used to generate provider data and reports, is preferred.
  • PC literacy required; MSOffice skills (Outlook, Word, Excel, PowerPoint, and Access) and knowledge of other Enterprise analytical systems.
  • Regularly required to operate standard office equipment (personal computer, photocopy machine, fax machine, etc.).
  • Ability to work on a computer up to 7 hours a day.
  • Regularly required to sit for long periods of time, and occasionally stand and walk.
  • Regularly required to use hands to operate computer and other office equipment.
  • Close vision required for computer usage. Occasionally required to stoop, kneel, climb, and lift up to 25 pounds.
  • Ability to travel. Must possess a valid driver's license and be able to drive a motor vehicle.
  • Ability to clearly present written information and findings. Ability to communicate concepts.
  • Ability to make executive-level presentations. Ability to interact well with co-workers and outside contacts.

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