Pune, India
Information Technology
Full-Time
Ceiyone
Overview
Experience: 5 – 8 Years
Location: Remote
Job Description:
- Works with stakeholders to discover, clarify, and document current and future data needs.
- Performs mapping of claims, insurance, and supplemental clinical data into a normalized data model.
- Serves as a subject matter expert on the Population Health and Insurance data domains such as Medical Claims, Pharmacy Claims, Dental Claims, Eligibility, Member PCP, Provider, Revenue.
- Builds data concepts to support Population Health and Insurance use cases.
- Serves as a key resource for an assigned customer area to understand and explain business and technical issues and to provide viable technology solutions.
- Supports clinical quality initiatives such as patient rosters and HEDIS.
- Supports value-based care KPIs, Health Plan operations, regulatory requirements, Medicaid, Medicare, and commercial populations.
- Supports Interoperability, Clinical Quality, Care Management, Analytics and Reporting, and Risk Management initiatives.
- Acts as a quality consultant and subject matter expert, performing testing and validation of the mapping of data elements to standards.
- Performs discovery and can efficiently analyze large data sets identifying gaps.
- Collaborates with technical resources to perform root cause analysis and complete remediation of data quality issues.
- Works with customers to clarify and plan for their current and future technology needs.
- Determines and maps existing business processes/functions and recommends changes required to fit a tightly integrated system.
- Designs and implements projects requiring systems integration, small teams, and multiple technical platforms.
- Conducts Return on Investment (ROI) and other financial analysis to support project funding/prioritization.
- Collaborates on driving improvement activities to achieve department and organizational goals.
- Coordinates with functional team to assure consistency and optimization of overall work product.
- Assumes a proactive role in driving improvement activities to achieve department and organizational goals to deliver value.
- Maintains current knowledge of industry and business process trends and applies that knowledge to existing business processes.
- Provides subject-matter expertise of Health Ministry processes, policies, and requirements in support of functional area process design, testing, and implementation.
- Identifies opportunities for process improvement and makes recommendations that lead to improvements.
- Monitors task assignments to ensure they are performed on schedule, within intended scope, and to a defined level of quality.
- Escalates process and project issues that cannot be resolved.
- Prior experience working as a Population Health, Insurance, or Claims analyst in the Healthcare system.
- Must have a working knowledge of relational databases/database structures, SQL experience desired.
- Must have a strong understanding of data collected and used in Rosters, Claims Processing, Eligibility, Health Insurance Exchanges, and Care Management Systems.
- Knowledge and experience with healthcare claims and billing workflows and clinical information systems.
Send your resumes to: career@ceiyone.com; saranya.ravikumar@ceiyone.com
Note: Please include the role in the subject line of the email.
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