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Business Intelligence Developer
2 months ago
Omni Inclusive is seeking a highly skilled BODS Developer to join our team. As a BODS Developer, you will be responsible for developing, implementing, and validating utilization and cost models that characterize providers' claims submissions and treatment patterns.
Key Responsibilities:- Develop and implement utilization and cost models to analyze 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 database integrity, and collect data for ad-hoc request reports and documentation.
- Prepare compensation reports and actuarial requests for compensation comparisons and analysis.
- Review and prepare reports, compile statistics, and analyze data regarding dentists requesting compensation changes.
- Coordinate collection of internal data to facilitate investigation of irregularities.
- Assist with onsite investigations into cases of suspected fraud or misrepresentation.
- Keep abreast of network infrastructure and leverage data sets to meet Enterprise business requirements.
- Review profiling parameters for statistical validity and recommend adjustments.
- Support Client Acceptance Testing of Enterprise-approved business applications.
- Troubleshoot and suggest improvements to systems and software applications.
- Bachelor's degree or equivalent education preferred.
- Minimum 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 of English grammar, composition, editing, proofreading, and strong verbal communication skills.
- Strong organizational/time management and project management skills.
- Basic knowledge of generally accepted accounting principles.
- Strong mathematical skills and ability to perform complex statistical calculations.
- Knowledge of health care industry issues 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.
- PC literacy required; MSOffice skills and knowledge of other Enterprise analytical systems.
