MVP Health Care-posted 3 months ago
Full-time
Schenectady, NY
Insurance Carriers and Related Activities

This position involves working in a virtual environment within New York State, focusing on the analysis of healthcare or health insurance data sets. The role requires a commitment to accuracy and timeliness in state and federal submissions, as well as regulatory reporting. The individual will be responsible for reconciling encounter data and conducting root cause analysis of rejections, ensuring high integrity in handling member eligibility, provider, medical and pharmacy data elements, and claim payment information. The position also emphasizes continuous monitoring of existing processes to identify discrepancies and implement improvements, alongside active participation in the development and testing of file extracts to meet vendor and regulatory agency requirements.

  • Responsible for state and federal submissions in an accurate and timely manner
  • Accountable for regulatory reporting within the organization and government entities
  • Reconciling encounter data and providing root cause analysis of rejections with member eligibility, provider, medical & pharmacy data elements, and claim payment information with high integrity
  • Continuously monitor the statuses of existing processes and identify discrepancies or process improvements
  • Actively participate in the development, testing, and implementation of file extracts and layouts to meet vendor and regulatory agency requirements
  • Possess excellent analytical skills with a focus on meeting the expectations and requirements of both internal and external customers
  • Be a self-motivated individual and have the ability to perform under pressure
  • Demonstrate excellent comprehension, written, and verbal communication skills
  • Contribute to the pursuit of excellence by performing various responsibilities that may arise, reflecting the goal of enhancing healthcare delivery and being the difference for the customer.
  • An Associate Degree in Health Administration, business, economics, or computer science
  • Three years of experience in a business environment involving the analysis of healthcare or health insurance data sets
  • Availability to work full-time, virtual within New York State
  • Intermediate SQL skills, able to write and debug queries
  • Proficient in Python, able to write and debug scripts
  • Proven ability to pull, analyze, report, and provide insight on large complex sets of data
  • Ability to identify areas of process improvement and implement automation efficiencies
  • Curiosity to foster innovation and pave the way for growth
  • Humility to play as a team
  • Commitment to being the difference for customers in every interaction
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