Health Care Analyst (32 Hour)

State of Connecticut•Waterbury, CT

4d•Onsite

About The Position

The Western Connecticut Mental Health Network (WCMHN), within the Connecticut Department of Mental Health and Addiction Services (DMHAS), is seeking a Health Care Analyst for its Quality and Information Management team. The role supports accurate, compliant billing and clinical documentation for Targeted Case Management, Behavioral Health Home, and Outpatient Services across WCMHN sites in Waterbury, Danbury, and Torrington. The analyst conducts audits, supports staff with documentation practices, analyzes audit results, and contributes to quality improvement and survey preparation. The job is part-time at 32 hours per week, Monday through Thursday, on the first shift from 8:00 a.m. to 4:30 p.m. The primary location is 95 Thomaston Avenue, Waterbury, Connecticut, with travel between the Waterbury, Danbury, and Torrington sites as needed. A comprehensive medical examination, including drug screening, is required following a conditional offer. The job class involves independently analyzing financial, utilization, and management records of health care facilities, providers, or health insurance providers. Duties may include reviewing records for compliance with Connecticut statutes and agency regulations, evaluating financial and utilization information, determining action steps, preparing reports, reviewing findings with audit and senior staff, and conducting research projects. For DMHAS, the job class also includes analysis of budgets, claims, expenditures, utilization, rate-setting, and revenue matters within behavioral health or skilled nursing facilities; analysis of General Assistance authorizations and expenditures; and possible review of patient eligibility and claims. The State of Connecticut offers comprehensive state benefits, professional growth and development opportunities, and a focus on work/life balance. Benefits may vary for part-time positions.

Requirements

Six years of professional experience in financial management, including some experience in health care management.
Financial management is defined as professional accounting or auditing work involving responsibility for reviewing and recommending financial policies and procedures of a business organization.
Knowledge of financial management principles and practices, including organization, administration, management, finance, budgeting, auditing, and accounting.
Knowledge of the health care industry.
Interpersonal skills and oral and written communication skills.
Ability to interpret and analyze complex financial, statistical, and technical data.
Ability to utilize computer software.
College training may substitute for general experience at 15 semester hours per one-half year of experience, up to four years for a Bachelor's degree.
A Master's degree in accounting, finance or another closely related field, or in public health with some college accounting or finance courses, may substitute for one additional year of general experience.
Professional experience in health care facility administration, health program administration, health insurance administration, health planning, or another health care-related field may substitute for general experience year for year, up to one year.
Successful completion of a Connecticut Careers Trainee program approved by the Department of Administrative Services may substitute for general experience.

Nice To Haves

Experience using advanced Excel features, including creating and modifying pivot tables, building complex formulas, and analyzing large datasets.
Experience with clinical documentation and billing requirements, including independently interpreting regulations, resolving complex issues, and serving as a resource to others.
Experience validating the plan of care and applying it to clinical documentation.
Experience creating audit reports and corrective action plans.
Experience with Joint Commission accreditation standards.
Experience applying regulations and standards pertaining to utilization review.
Experience using computer software, including Excel and Access databases, and presenting data.

Responsibilities

Conduct monthly billing and medical record audits to ensure accuracy, compliance, and data integrity.
Review documentation for completeness and adherence to regulatory and agency standards.
Use software and reporting tools to extract data, generate reports, and analyze audit outcomes.
Recommend improvements based on audit findings and follow up with staff on required corrections.
Serve as liaison with the DMHAS Commissioner's Office on billing and claims matters.
Provide training and develop materials to support accurate billing and documentation practices.
Participate in quality improvement projects and assist with Joint Commission, CMS, and other survey preparations.
Travel between Waterbury, Danbury, and Torrington sites as needed.
Review health care materials and records for compliance with Connecticut statutes and agency regulations.
Evaluate financial, utilization, and management records and determine appropriate action steps.
Prepare financial, narrative, and statistical reports; review findings and conclusions with audit staff and senior staff.
Perform special research projects and related duties as assigned.
For DMHAS job-class duties, prepare, analyze, and evaluate budget, claims, expenditure, utilization, rate-setting, and revenue issues within behavioral health or a Skilled Nursing Facility.
Analyze General Assistance authorizations and expenditures, rate-setting scenarios, and new methodologies; review patient eligibility coverage and recommend claims actions when needed.