HealthCare Claims Analyst

Position: Health Care Claims Analyst

Location: Hybrid (Must Reside in NY/NJ/CT)

Compensation: $65,294.40 - $72,277

SQL CODING EXPERIENCE REQUIRED

Village Care is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services. Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care.

Village Care has delivered quality health care services to individuals residing within New York City for over 45 years.

The Full-Time Health Care Claims Analyst position at Village Care requires a seasoned professional with a minimum of five years of experience in healthcare claims reporting and processing, alongside in-depth knowledge of Medicaid and Medicare guidelines. The ideal candidate should possess advanced SQL coding and Excel skills to create insightful reports and dashboards. You will play a critical role in understanding healthcare reimbursement from both financial and operational perspectives, conducting audits, and performing root cause analysis to resolve identified issues with internal teams and third-party administrators (TPAs).

This position involves identifying gaps in various aspects of claims processing, communicating trends and contract issues to management, and preparing comprehensive narratives and visual aids for leadership presentations. You will also coordinate workflows across departments, ensure compliance with regulations, and contribute to the development of policies and quality assurance measures. Your analytical skills will be essential in evaluating claims system coding to validate pricing and improve overall operational efficiency.

To excel as a Full-Time Health Care Claims Analyst at Village Care, candidates must possess a Bachelor's Degree in a relevant field such as Computer Science, Mathematics, Statistics, or Engineering, with a Master's degree preferred. A minimum of 3-5 years of experience in business intelligence and analytics is crucial, particularly in a healthcare environment where complex data analysis and report/dashboard development are key responsibilities.

Familiarity with medical terminology and coding systems, including ICD-10, CPT, HCPCS, along with knowledge of CMS guidelines and Encoder Pro, is essential. The analyst should demonstrate excellent technical proficiency in tools such as MS Excel, SQL, Tableau, and Access.

Strong communication skills, both written and verbal, are imperative for effectively conveying analytical findings and collaborating with various departments. The ability to work independently while maintaining a high level of productivity will significantly contribute to success in this role.

Knowledge and skills required for the position are:

• Education:
  
  Bachelor's Degree required ideally in a relevant field such as Computer Science, Mathematics, Minimum Statistics and/or Engineering. Master's degree preferred.
• This position requires a minimum of 3-5 years' experience in business intelligence and analytics performing increasingly complex data analysis and report/dashboard development preferably in a healthcare setting.
• Knowledge of medical terminology, ICD-10, CPT, HCPCS coding CMS guidelines and Encoder Pro are required.
• Must be able to work independently with high level of productivity and advanced written and verbal communication skills.
• Excellent technical skills (MS Excel, SQL, Tableau, Access, etc.)
  · Strong communication skills.

MUST RESIDE IN NY, NY OR CT