1+ months

TPL Business Data Analyst - Reclamation SME

Sunrise, FL 33351
Regular Full Time
   

Responsibilities:
We are seeking a data analyst with strong healthcare knowledge and subject matter expertise in Third Party Liability (TPL) coordination of benefits and reclamation practices. This position will support both existing programs as well as new client implementations by analyzing TPL-related eligibility and claiming data to develop the processes, procedures, and technical documentation needed to create, deliver, and successfully resolve TPL reclamation claims.

Essential Duties:
Leverage knowledge and expertise in eligibility and reclamation practices to review and understand TPL-related data.  
Assist technical and business leads with data file mapping, cross-walking, and other analytics tasks required to develop and implement TPL reclamation processing.
Serve as a subject matter expert (SME) for back-end TPL reclamation operations, including requirements gathering, documentation, project management, and quality assurance for new implementations and existing program changes.
Review and analyze TPL data to identify trends, patterns and identify impact across various products. 
Develop custom queries and reporting, conduct research, analyze trends and activities, and presents data and findings based upon business needs and as need to identify opportunities, root causes of issues and to support business decisions and strategies.
Assists operations team with review of identification and resolution of reclamation-related business issues.
Identify and research general changes and trends in the health insurance market.
Conducts a variety of data analysis for intelligent insights using subject matter knowledge, independent judgement, and analytical expertise.
Follows and complies with company, departmental and client program policies, processes, and procedures.
Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
Successfully completes, retains, applies, and adheres to content in required training as assigned.
Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note: client/government clearance requirements are not determined or decisioned by Performant.)
Demonstrates Performant core values in performance of job duties and all interactions.
Correct areas of deficiency and oversight received from quality reviews and/or management.
Other duties as assigned.

Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.

*Note - All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times.  Violations to Performants policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

 


Required Skills and Knowledge:
Knowledge of and ability to work with large volumes of health care eligibility and claims data
Extensive experience with post-payment reclamation for Medicaid / Medicare / Other TPL business models and products
Advanced knowledge of data file analysis, mapping, documentation, requirements gathering, ETL processing, and data matching
Strong system skills with ability to quickly develop expertise in new systems and applications
Advanced skills in Excel, Access and/or other data analysis applications
Working knowledge of SQL or equivalent tools
Working knowledge of X12 EDI Transactions, including, but not limited to 270/271, 834, 277, 837, 835 
Professional verbal and written communication with good presentation skills
Able to work independently and meet deadlines with minimal supervision
Strong problem solving and communication (written and oral) skills
Ability to produce results and maintain positive attitude in fast paced, dynamic environment
Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail
Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.

Physical Requirements:
Performs duties in a busy standard office environment with moderate noise level. (or home-based Telework environment in accordance with Company policies and procedures).
Sits or stands at a desk, reaching as needed to use office equipment.
Makes and returns calls using an office phone system. 
Views a computer monitor, types on a keyboard and uses a mouse.
Reads and comprehends information in electronic (computer) or paper form (written/printed).
Types frequently, but not constantly, using a keyboard and mouse.
Occasionally lifts/carries/pushes/pulls up to 10 pounds.

 


Education and Experience:
Bachelors degree in relevant field or equivalent combination of education and experience.
3+ years relevant experience working with healthcare eligibility and claim data
Experience with data modeling and analysis
Knowledge and experience with Healthcare, Coordination of Benefits, Third Party Liability, and/or Medicare Secondary Payer


Other Requirements:

Must submit to and pass pre-hire background check, as well as additional checks throughout employment
Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.
Must submit to and pass drug screen pre-employment (and throughout employment).
Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company.
  
Visa sponsorship is not available.

Job Profile is subject to change at any time.

EEO 
Performant Financial Corporation is an Equal Opportunity Employer. 
Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law. 

 

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZED AGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER
   


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Categories

Posted: 2021-03-16 Expires: 2021-06-13
Analytics, audit, and recovery services for healthcare, government and student loans.

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TPL Business Data Analyst - Reclamation SME

Performant Financial
Sunrise, FL 33351

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