Job Location: Rancho Cucamonga, CA
Position Summary/Position
Under the direction of the department leadership team, the Healthcare Data Analyst II – Provider Configuration & Claims Ops (HDA II) is responsible for end-to-end Private Hospital Directed Payments (PHDP) and Enhanced Payment Program (EPP) processes. Including but not limited to the following: reconciliation of contracted hospitals 837 transactions, validation of encounter data submitted to DHCS via 837, analyzing and identifying the root cause of 837 transaction errors and encounter data rejections, communication with providers or internal with departments or trading partners to review processes and programming opportunities to minimize errors and enhance the quality of the data to address any issues.
The HDA II must have working experience in designing relational databases, complex query logic. In addition to technical data concepts, the HDA II must have experience in financial analysis or healthcare data analysis in a health plan setting (or equivalent healthcare organization).
The HDA II presents study/analysis results to various audiences throughout the organization, including the leadership team. Major Functions (Duties and Responsibilities)
1. Serve as technical lead in analysis and reporting efforts that support the department in PHDP/ EPP healthcare data analyses, including but not limited to, reconciling with IEHP Contracted hospitals, collaborating with contracted hospitals once encounter data is available from DHCS.
2. Download PHDP/EPP data via IEHP SFTP site and validate DHCS provided data for all IEHP/IPA Contracted hospitals.
3. Generate a file for each contracted IEHP/IPA hospital and notify hospital via email that PHDP/EPP files are ready to for them to review.
4. Conduct root cause analysis for any issues identified by the hospital, correct any 837 processing errors, and encounter data rejections in the encounter data system tracking system, and collaborate with EDI to resubmit corrected encounter data files.
5. Communicate findings with Hospitals via IEHP SFTP.
6. Follow CMS and DHCS Claims processing guidelines and industry standards in correcting encounters.
7. Collaborate with contracted providers, vendors, and trading partners to address issues related to processing 837 transactions and encounter data rejections.
8. Ensure a payment letter/Remittance Advice (RA) is generated for each hospital9. Exercises timely and accurate data mining techniques and develops new or modifies existing reports that ensure consistent conclusions to data analysis.
9. Exercise timely and accurate data mining techniques and develops new or modifies existing reports that ensure consistent conclusions to data analysis.
10. Design and enhance databases to support reporting and analysis needs, including testing, validating, and maintaining data integrity and accuracy, across multiple databases.
11. Use analytical skills to determine solutions and resolve problems.
12. Evaluate report requests to determine requestor’s needs and objectives, identifying correct methodology for extracting data including data sources and criteria, and ensuring the delivered report is accurate, timely, and formatted appropriately.
13. Significant participation in analysis, interpretation, and translating of complex health plan data, issues, trends, and relationships into effective strategies and action plans.
14. Manage assigned projects and effectively communicating with the leadership team any project deadlines that may be in jeopardy of being met, well in advance of the due date.
15. Present findings of analyses to various staff levels including executive team, leadership team and staff levels. Present results in formats that are easy to understand and appropriate to the audience.
16. Obtain Joint Operations Meeting (JOM) schedule and create Power Point presentation for each hospital with their results.
17. Document all analysis / reporting projects following established protocols, ensuring replication of results by an independent reviewer.
18. Demonstrate a commitment to incorporate LEAN principles into daily work.
19. Establish and maintain effective working relationships with others throughout the organization.
20. Perform special projects and other duties as assigned by the department leadership team. Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leading: Self Experience Qualifications
Three (3) years of relevant experience. Demonstrated experience working with large data sets and relational database structures. Preferred Experience Education Qualifications
Master’s degree from an accredited institution required.
Significant experience may be considered in lieu of degree: In lieu of a Master’s degree, a minimum of five (5) years of relevant work experience with a Bachelor’s degree is required. Preferred Education Professional Certification Professional Licenses Drivers License Required No Knowledge Requirement
Knowledge of all applicable billing and coding regulations with focus in the areas of Medicare, Medi-Cal, NCCI and MUE requirements for compliant billing. Knowledge of ANSI x12 and EDI Standards 837I and 837P, 999s and 277s. Working knowledge of data analysis, study methodology, and preparing professional documents. Basic understanding of statistical methods. Working knowledge of Microsoft Access, SQL, SAS, or other equiv. data program language are essential. Skills Requirement
Data analysis, data presentation, spread sheet and database capabilities. Excellent interpersonal/ communication skills. Proficiency in Microsoft Excel, Word and Power Point required. Abilities Requirement
Strong problem-solving capability. Strong attention to detail. Ability to effectively analyze large/complex datasets. Ability to present reports / data analysis findings in group settings. Ability to manage multiple projects with time-sensitive deadlines is a must. Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions
Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership. Work Model Location Telecommute Physical Requirements Hearing: One-on-One – FREQUENTLY Near Visual Acuity – FREQUENTLY Communicate: Information/ideas verbally – FREQUENTLY Regular contacts: co-workers, supervisor – FREQUENTLY Memory – FREQUENTLY Understand and follow direction – FREQUENTLY Regular and reliable attendance – CONSTANTLY Keyboarding: 10-Key – FREQUENTLY Keyboarding: Touch-Screen – FREQUENTLY Keyboarding: Traditional – FREQUENTLY Sitting – CONSTANTLY Indoors – FREQUENTLY Lighting – CONSTANTLY
Starting Salary: $91,000.00 – $116,022.40
Pay rate will commensurate with experience
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
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