Providence St. Joseph Health

Job Information

St. Joseph Health / Covenant Health Data Analyst - Compliance in Anaheim, California

We are looking for a Data Analyst with HSS Compliance Department at St. Joseph Heritage Healthcare.

Location: Anaheim, CA

Schedule: Full-time 80 Biweekly Hour

Shift: 8 Hour Day Shift

Job Summary:

The Data Analyst for Regulatory Compliance Reporting Analyst will compile and analyze reports for submission for the Health Plan Audits for their respective Product Lines (Commercial, Senior, and Medical) which impact 10 Health Plans. This position will support internal department reporting needs to fulfill business requirements. This role has strong interaction and collaboration across SJHH NSS and Care Integration (NSS Support Services, Claims, Claims Auditing, UM, and CM) operations. In addition, this position provides reports to a variety of customers, both internal and external on a regular basis. Reports will include UM reporting activities, Provider Dispute Resolution, Re-Opening for Senior Claims, FEHBP, Claims Inventory, Misdirected Claims, Medicare Interest Rate and Claims Pricing, MTR, Monthly NSS, Board Foundation, and Regional Report. Manage the flow of scheduled reports to ensure customer deadlines and health plan audit compliance requirements are met.

Skills:

  • Familiar of claims processing rules, Managed Care Benefits, claim adjudication required, and/or utilization management prior authorization and denial rules.

  • Requires thorough knowledge of Healthcare data elements.

  • Knowledge of Managed Care Benefits and adjudication, Utilization Management regulatory processes, and Claims administration, including medical terminology, CPT, Revenue Codes, and HCPS codes required.

  • Requires accurate data entry skills.

  • Ability to communicate via e-mail operating environment required.

  • Requires intermediate or advanced knowledge of Microsoft Applications: Word, Access- including creating tables, writing queries, creates forms and reports, Excel, and Visio- create and modify workflow processes.

  • Ability to learn to understand various formats, connectivity and interaction among various computer platforms and operating systems related to EDI systems.

  • Working with data, the ability to manipulate spreadsheets, and perform quantitative and qualitative analysis.

  • Knowledge of HIPAA Regulation and California State Law.

  • Ability to work in a fast-paced department and handle multiple tasks, work with interruptions, and deal effectively with confidential information.

  • Ability to work under minimal supervision and exercise independent judgment and tact in handling highly confidential information on training scores and refresher training requests.

  • Possess effective documentation skills, critical thinking and problem solving skills.

  • Possesses excellent interpersonal skills to achieve desired goals and to interact effectively with management, non-management personnel, and vendors.

  • Possess working knowledge and understanding of Medicare, Medical, and commercial coverage, utilization management processing rules, claims processing rules, and healthcare regulatory environment.

  • Possess strong written and verbal communications skills to communicate effectively with individuals at all levels of the organization.

  • Familiarity with Medicare, Commercial, Medi-Cal/Medicaid requirements preferred.

  • IDX and Microsoft Project is preferred.

Position Requirements:

Education: Associate's Degree or equivalent educ/experience

Experience:

  • 1 year Experience compiling reports in a Healthcare related business, preferably in a health plan environment.

  • 1 year Experience supporting users with reporting requirements.

  • 1 year Audit and compliance experience.

  • Recent experience working with Claims and Utilization Management related data.

  • Experience with HIPAA Regulation and California State Law.

Preferred Position Requirements:

Education: Bachelor's Degree

Experience:

  • 2 years Experience compiling reports in a Healthcare related business in a health plan environment.

  • 2 years Experience supporting users with reporting requirements.

  • 2 years Experience in a healthcare organization working with health plan or government regulations.

  • 2 years Audit and compliance experience.

  • Recent experience working with Claims or Utilization Management related data in the Medicare, Medical or Commercial healthcare environment.

St. Joseph Health - Mission Heritage Medical Group is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, Mission Heritage Medical Group has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.St. Joseph Health - Mission Heritage Medical Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Mission Heritage Medical Group complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Company: Heritage Healthcare

Category: Analytics/ Business Intelligence

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