Analyze data to assist in the design of Value Based Programs.
Develop analytic and/or report requirements that support informed decisions regarding strategy initiatives.
Help identify, research, and resolve operational and other business issues relating to value-based programs and initiatives.
Capital Blue Cross is committed to the health and well-being of its members and communities. They have been voted as one of the “Best Places to Work in PA” and foster a flexible environment where employees are encouraged to volunteer and grow professionally.
Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote them one of the “Best Places to Work in PA” and they recognize that work is a part of life, not separate from it, and foster a flexible environment.
Maintain internal CMS HCC and RxHCC models for calculating member level risk scores.
Support the monthly close process, including the development of actuarial risk adjusted revenue accruals and analysis of results.
Build reports to track ROI on various risk adjustment initiatives.
Clover Health is reinventing health insurance by combining the power of data with human empathy to keep their members healthier. They are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
Perform comprehensive analysis of healthcare claims data using advanced statistical and analytical methods; prepare reports summarizing key findings.
Collaborate with management, investigators, and analysts to support proactive and reactive case development efforts by fulfilling data requests.
Apply techniques such as data mining, statistical modeling, and predictive analytics to identify anomalies in Medicare/Medicaid claims.
CoventBridge Group is a global full-service investigation firm providing data analytics and investigative solutions to government and commercial clients. They have 1000 employees and affiliates worldwide and are committed to top tier data privacy and security practices.
Serve as an integral part of HSAG Data Science & Advanced Analytics division.
Exhibit the ability to learn about the primary types of healthcare data and methods for approaching data assessments.
Conduct and interpret analyses, develop appropriate statistical models, manipulate complex databases, and track and evaluate patterns of care and outcomes.
Health Services Advisory Group (HSAG) is a nationally recognized leader in healthcare data analysis, measure development, and survey research. They are transforming the delivery of healthcare in the United States with a growing team and offer opportunities to give back to the community.
Support management of internal MGA programs, optimizing multiple areas.
Use data analyses to identify opportunities impact instant price and written premium.
Make recommendations on pricing through profitability analyses and market trends.
Zensurance is redefining commercial insurance for Canadian businesses by making getting the right coverage simple, fast, and accessible through a digital-first experience. They are a leading InsurTech that values ownership, collaboration, and innovation and has been recognized by Deloitte’s Technology Fast 50.
Responsible for analyzing accounts receivable, monitoring performance, and performing technical and analytical functions to support the revenue cycle.
Uses technical tools and functional knowledge to create long term and ad hoc solutions that create visibility for stakeholders and drive operational excellence.
Completes variance analysis relative to budget or pro forma targets, researches root causes for variance, and reports findings to management.
NorthStar Anesthesia is a company of caregivers, founded by an anesthesiologist and a Certified Registered Nurse Anesthetist (CRNA). With more than 4,000 anesthesiologists and CRNAs under its banner, NorthStar partners with more than 280 client sites across over 20 states and counting to deliver a more productive and efficient model of anesthesia care.
Work closely with leaders to analyze and understand both internal and external needs.
Establish and execute product ownership strategies related to data products.
Act as a Subject Matter Expert (SME) for analytics methodology design and implementation.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Work with Data Exchange partners and internal teams to maintain Data Exchange data feeds.
Serve as a point of coordination for Data Exchange identification and issue resolution.
Proactively monitor system status to quickly identify potential abnormalities.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They offer full-service health benefit management solutions to employers, TPAs, and health plans.
Own analytical framing and execution for high-stakes business questions related to value creation, strategy, and operational performance
Define and maintain trusted KPIs and Snowflake data marts using DBT to ensure reliable, decision-ready data foundations
Design and maintain executive dashboards in QuickSight that answer meaningful business questions and reduce metric ambiguity
Firsthand supports individuals living with serious mental illness (SMI). Their teams focus on meeting each individual where they are and walking with them side by side as a trusted guide and partner on their journey to better health.
Be responsible for the monitoring and management of the end to end data flow of data submissions to vendors and government agencies to mitigate data leakage and submission errors.
Own the claim and supplemental submission workflow for CMS EDS submissions.
Develop data pipeline tracking reports and analyze, research, and resolve encounter data errors.
Clover Health is reinventing health insurance by combining data with human empathy to keep members healthier. They've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most. They are passionate and mission-driven individuals with diverse areas of expertise. From Clover’s inception, Diversity & Inclusion have always been key to their success.
Identify & size actionable opportunities using data.
Partner cross-functionally to prioritize and implement optimizations.
Shape strategic and tactical roadmaps to meet channel goals.
Liberty Mutual aims to be the #3 direct carrier serving the mass market. They offer comprehensive benefits, workplace flexibility, and professional development opportunities.
Partners with Revenue Cycle stakeholders to define KPIs and translate needs into analytics requirements.
Develops scalable analytics content using Power BI and Microsoft Fabric ecosystem.
Translates data into clear insights and manages multiple initiatives independently.
Emory Healthcare fuels their employees' professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs, and a supportive environment. They enable their employees to reach new heights in their careers and be what they want to be.
Monitors for changes in existing business processes and updates documentation accordingly
Finds new opportunities for process developments and improvements
Drives root-cause-analysis and resolution of data and processes issues/errors by partnering with key stakeholders
Judi Health is an enterprise health technology company providing solutions for employers and health plans. They offer full-service pharmacy benefit management and health benefit management solutions on its proprietary Enterprise Health Platform.
Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines.
Supports IA and SIU with assistance as needed.
Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented.
Capital Blue Cross is committed to going the extra mile for their team and community. It's why their employees consistently vote them one of the “Best Places to Work in PA.”
Review payer financial reconciliations for accuracy and adherence to agreed-upon methodologies.
Support for the development and deployment of audit procedures applied to payer data sets.
Partner across teams and with payers to resolve data discrepancies.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. They are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Conduct complex analytic studies using statistical techniques on healthcare data.
Present findings through charts, tables, and graphs for easy interpretation.
Create and maintain efficient statistical and analytic code using tools such as Python, SAS, Stata, R.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. They identify the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Provide insights and recommendations to support internal customers and state partners.
Evaluate performance, identify trends, and make recommendations for improvements.
Lead workstreams on projects and present analyses to Product Managers.
Liberty Mutual strives to create a workplace where everyone feels valued and supported. They foster an inclusive environment with comprehensive benefits, flexibility, and professional development opportunities. They value hard work, integrity, and commitment.
Collaborate with implementation teams and external customers to ensure data integrity and interface validation for symplr software solutions.
Analyze and manage patient healthcare data for consistency and accuracy while configuring system software during implementation projects.
Leverage analytical, technical, and communication skills to define processes for clinical data management and assist customers in achieving their organizational goals.
Symplr is revolutionizing healthcare operations with a first-of-its-kind platform that drives effective, efficient, and connected workflows, increasing operational benefits and scaling clinical, financial, and quality outcomes. We are a remote-first company with employees across the United States, India, and the Netherlands.