Claims Management - Quality & Data Integrity Analyst
Our goals are to provide excellent service, utilize advanced technology, and proficiently deliver results. To accomplish these goals, we constantly seek individuals who look for ways to do things better. We are a company whose
cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement.
Tabula Rasa HealthCare (TRHC) is a leader in providing patient-specific, data-driven technology and solutions that enable healthcare organizations to optimize performance to improve patient outcomes, reduce hospitalizations, lower healthcare costs, and manage risk. Medication risk management is TRHC’s lead offering, and its cloud-based software applications, including EireneRx® and MedWise™, provide solutions for a range of payers, providers and other healthcare organizations.
TRHC empowers our employees to provide excellent service, utilize advanced technology, and proficiently deliver results. Our 32Fundamentals are what we are and who we are. Our culture cultivates teamwork, rewards excellence, focuses on quality for every aspect of our business, and promotes community involvement. As a part of our team, you will help us bring innovative service models to healthcare, improving patient outcomes.
Job Description: Quality & Data Integrity Analyst
Summary: Under the supervision of the Director of Implementation & Reporting, the Quality & Data Integrity Analyst has primary responsibility for developing and generating operational, key performance indicator (KPI), dashboard, State and Center for Medicare and Medicaid Services (CMS) reporting.
Own assigned reports or functional area reporting including:
- the development of new and ad-hoc reports
- drafting of business and technical requirements
- maintenance of reports including making modifications as directed by the business or due to business process changes
- testing reports to support system upgrades and updates, and other business process changes that may impact the accuracy of the report
- ensure timely and accurate delivery of reports to business owners and stakeholders.
Identify, report and remedy data issues/discrepancies working collaboratively with all appropriate parties.
Complete routine quality assurance checks to ensure data accuracy and completeness and execute corrections as needed.
Stay up-to-date on CMS changes and assist with the development of new business requirements and functional specifications as they relate to regulatory reporting
Assists with and leads special projects, as requested
Communicates clearly and concisely, with sensitivity to the needs of others
Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees
Maintains courteous, helpful and professional behavior on the job
Establishes and maintains effective working relationships with co-workers
Follows all Policies and Procedures and HIPAA regulations
Maintains a safe working environment
Supervisory Responsibility: None
FLSA Status: Exempt
Travel: No travel is anticipated for this position
Knowledge, Skills and Abilities:
Educational requirements: Associates Degree required.
Three years of professional work experience in a TPA or insurance company setting is strongly preferred
Minimum of three years using SQL for reporting functions is required.
Experience with reporting tools.
Knowledge of managed care operations including enrollment, provider contracts, credentialing, fee schedules and payment methodologies, medical terminology, and claims processing.
Knowledge and experience using current computer technology, and a strong knowledge of Excel and Microsoft Word.
Technical ability to learn and navigate new systems
Skilled in establishing and maintaining effective working relationships with clients, and staff at all levels
Skilled in data analysis and problem solving using defined methodologies
Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
Ability to work independently with minimal supervision
Ability to independently follow through on projects
Ability to communicate professionally, clearly and effectively, verbally and in writing
Ability to prioritize effectively
Ability to consistently multitask
The Company is proud to be an equal opportunity employer. All qualified applicants will receive consideration without regard to ancestry or national origin, race or color, religion or creed, age, disability, AIDS/HIV, gender, marital or family status, pregnancy, childbirth or related medical conditions, genetic information, military service, protected caregiver obligations, sexual orientation, protected financial status or other classification protected by applicable law.
- Pay Type Hourly
- Required Education Associate Degree