Financial Accounting Healthcare Claims and Data Analyst - Power BI

About the position

The Healthcare Claims Reviewer and Data Analyst at Novum Health is responsible for ensuring the accuracy and efficiency of healthcare claims processing and data management. This role involves analyzing claims data to identify trends and discrepancies, preparing reports for leadership, and collaborating with cross-functional teams to enhance operational efficiency. The position requires a strong understanding of healthcare regulations and coding, as well as proficiency in data analysis tools.

Responsibilities

• Conduct thorough reviews of healthcare claims to ensure accuracy and compliance with payer regulations.
• Analyze claims data to identify trends, outliers, or discrepancies that may indicate billing errors or potential fraud.
• Prepare detailed reports and dashboards to present key insights to leadership.
• Collaborate with cross-functional teams to streamline the claims review process and ensure data integrity.
• Generate reports and analyze claims data to identify trends, patterns, and opportunities for process improvement.
• Conduct audits of claims processes and documentation to ensure compliance with regulatory requirements and internal policies.
• Develop and maintain databases or systems to store and manage claims data effectively.
• Participate in meetings or discussions to provide insights and recommendations based on claims data analysis.
• Assist in developing predictive models for claims forecasting and identifying areas of cost containment.
• Assist in the development and implementation of strategies to enhance claims processing efficiency and accuracy.
• Stay updated on industry changes, regulations, and best practices related to claims processing and data analysis.

Requirements

• A minimum of 2 years of experience in healthcare claims analysis, medical billing, or healthcare data analysis, or a related role within the healthcare industry.
• Strong understanding of medical coding, billing procedures, and healthcare claims processing.
• Proficiency in healthcare claims management systems and data analysis tools (e.g., Excel, SQL, or Power BI).
• Bachelor's degree in healthcare administration, business, data analysis, or a related field (or equivalent combination of education and experience).
• Certification in claims analysis or data analysis (e.g., Certified Professional in Healthcare Quality) is preferred.

Nice-to-haves

• Familiarity with healthcare claims cycle, including submission, denial management, and compliance with payor guidelines.

Benefits

• Competitive salary starting from $68,000 per year.
• Full-time employment with a structured 8-hour shift.