Senior Financial Healthcare Data Analyst III
About The Position
The Senior Financial Healthcare Data Analyst III independently leads complex, high-importance projects, managing their development and implementation. The role analyzes project objectives, data sources, methodologies, summaries, and findings, and prepares and edits reports for project sponsors. It coordinates and prioritizes work with internal and external staff, monitors accuracy, and ensures outcomes support HMSA’s corporate goals. The position develops, analyzes, recommends, and monitors reimbursement and provider strategies. It prepares reports measuring reimbursement and contracting effectiveness and their impact on program or plan costs and utilization. The analyst identifies trends and cost-reduction opportunities, monitors market developments and reimbursement or policy changes—particularly those from government entities—and recommends implementation actions. The role also communicates with physicians, hospital administrators, other health insurers, auditors, and internal departments. The analyst conducts annual reviews of compliance workflows, including SSAE and MAR; participates independently in audits and responds comprehensively to auditor inquiries; and reviews provider contracts to verify that claims-system setups accurately reflect executed agreements. The role mentors team members and provides feedback and direction on their work. It also performs other assigned duties and serves as a courteous, caring, helpful, respectful, and service-oriented role model when interacting with members, visitors, the public, and employees.
Requirements
- Bachelor’s degree and five years of related work experience, or an equivalent combination of education and experience.
- Proficiency in data reporting and analysis.
- Demonstrated working knowledge of managed care or healthcare business processes and systems and applications for claims payment, network, and provider contract administration.
- Proficiency in project management skills.
- Intermediate working knowledge of Microsoft Office applications, including Word, PowerPoint, and Outlook.
- Advanced working knowledge of Microsoft Excel.
- Advanced working knowledge of MicroStrategy, SQL, SAS, or another query language.
Responsibilities
- Independently lead complex, high-importance projects; plan and manage project development and oversee implementation.
- Analyze project objectives, data sources, methodologies, summaries, and findings; prepare and edit draft, revised, and final reports for project sponsors according to information-request specifications.
- Coordinate and prioritize activities with internal and external staff, monitor work for accuracy, and ensure outcomes meet HMSA’s corporate goals.
- Develop, analyze, recommend, and monitor reimbursement and provider strategies.
- Prepare reports measuring the effectiveness of reimbursement and contracting terms and their influence on program or plan cost and utilization.
- Analyze data to identify trends, patterns, notable issues, and cost-reduction opportunities; monitor market trends for emerging business opportunities or risks.
- Monitor websites for reimbursement and policy changes, with a focus on government entities, and recommend implementation of changes.
- Communicate with physicians, hospital administrators, other healthcare insurers, auditors, and internal departments.
- Conduct annual reviews of compliance workflows, including SSAE and MAR.
- Participate independently in current audits and respond comprehensively to auditor inquiries.
- Review provider contracts and ensure claims-system setups accurately reflect fully executed, signed agreements.
- Mentor team members and provide feedback and direction on their work.
- Perform other assigned or directed duties and model courteous, caring, helpful, respectful, and service-oriented conduct.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
