Rochester, New York - Posted on: Friday 03/21/14
Under the direction of the Manager, Revenue Data Management:Responsible for the accuracy of Government Programs and Commercial data (On & Off the Health Insurance Exchange
Marketplace) including but not limited to member eligibility, provider, medical & pharmacy encounters and payment. Reconcile data and payment, and ensure complete, accurate and timely revenue within CMS/HHS and state guidelines.
Must constantly monitor the status of new, existing, and previous discrepancies or recovery situations. Actively participate in the development, testing and implementation of file extracts and layouts to meet vendor and regulatory agency
requirements. Oversee the extraction, integrity and submission of data. Analyze Government Programs and Commercial (On & Off the Health Insurance Exchange Marketplace) data to report trends and recommendations to management.
Performs other duties as assigned.
Minimum Education: BA Degree in Health Administration, business, economics, computer science or related field.
Analyst level, minimum of 3 years experience in a business environment involving the analysis of financial or member data. Of the three years, one full-time year must be in financial data reconciliation. Experience working with external
parties, vendors or government agencies. Sr Analyst level, minimum of 5 years experience in a business environment involving the analysis of financial or member data. Of the five years, one full-time year must be in financial data
reconciliation and working within the X12 Transactions Post-Adjudicated Claims Data Reporting (PACDR) Standards; specifically the Professional (837) & Institutional (837) files. Must also have at least one year working with 820 remittance
files. Experience working with external parties, vendors or government agencies.
- Demonstrated problem-solving and analytical abilities.
- Demonstrated ability to work independently with strong attention to detail.
- Demonstrated excellent written and verbal communication skills.
- Intermediate Microsoft Word
- Intermediate Excel - Proven ability to create formulas for financial calculations
- Intermediate Access skills - Proven database development; ability to write queries and create macros
- Intermediate processing skills for use in data warehouse applications, including ability to identify appropriate data fields
and write queries to obtain accurate information.
- Proven ability to pull, analyze, report and provide insight on large sets of data
- Extensive reading to stay abreast of the frequent changes in federal and/or state regulations.
- Minimal travel required.
- Working knowledge of Risk Adjustment
- Working knowledge of ICD-9, ICD-10, CPT, HCPCS and revenue codes.
- Intermediate SQL skills
- Knowledge of Centers for Medicare and Medicaid Services (CMS) and state agency guidelines.
- Knowledge of revenue and data issues relating to CMS/HHS & state agencies
- Previous Health Insurance experience