Data Analyst II Healthcare Analytics

by Irma Moore | Mar 12, 2025 | Uncategorized

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to identify areas of value, develop solutions, and deliver insights to reduce overall cost of care for members and improve their clinical outcomes.

• Interpret and analyze data from multiple sources including healthcare provider, member/patient, and third-party data
• Support execution of large-scale projects with limited direction from leadership
• Identify and perform root-cause analysis of data irregularities and present findings and proposed solutions to leadership and/or customers
• Manage multiple, variable tasks and data review processes with limited supervision within targeted timelines
• Support the design, testing, and implementation of process enhancements and identify opportunities for automation
• Apply expertise in quantitative analysis, data mining, and the presentation of data to see beyond the numbers and understand how customers interact with analytic products
• Support multiple functions and levels of the organization and effectively, both verbally and visually, communicate findings and insights to non-technical business partners
• Independently engage with customers and business partners to gather requirements and validate results
• Communicate and present data-driven insights and recommendations to both internal and external stakeholders, soliciting and incorporating feedback when required
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Bachelor’s degree in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance or related field or equivalent experience. 2+ years of experience working with large databases, data verification, and data management, or 1+ years IT experience. Healthcare analytics experience preferred. Working knowledge of SQL/query languages. Preferred knowledge of programmatic coding languages such as Python and R. Knowledge of statistical, analytical, or data mining techniques including basic data modeling, trend analysis, and root-cause analysis preferred. Preferred knowledge of modern business intelligence and visualization tools. Experience in provider contracting, claims pricing, financial reporting/analysis, data modeling, statistical modeling, data science, or geospatial/reimbursement analysis preferred.Pay Range: $55,100.00 – $99,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Credentials Associate – REMOTE

by Irma Moore | Mar 11, 2025 | Uncategorized

City/StateNorfolk, VA

Overview

Work ShiftFirst (Days) (United States of America)

Sentara Health is currently seeking a Credentials Associate for our Sentara Hospitals. This is a Remote position.  

Hours/Shift: Full-Time, Day Shift (Remote Day Shift hours are typically between the hours of 8 a.m. to 5 p.m.)

Position Overview:

As a Credentials Associate with Sentara, you will conduct data gathering, verification and analysis of practitioner applications and credentials for medical staff and affiliate appointment and privileges through both the Initial and Reappointment Application process. Responsible for maintaining all credentials files either in paper or electronic format and maintains data in system-wide database.

Job Requirements:

• 3 years of Credentialing Experience is REQUIRED. Credentialing in a hospital, health plan, or CVO environment is Required (Medical Staff Office Coordinators or specialists in the privileging Medical Staff Office) or credentialing office in hospital, health plan, or CVO environment is Required.
• CPCS – Certified Provider Credentialing Specialist preferred.
• Proficiency in Echo and/or CredentialStream Database Management preferred.
• Microsoft Word and Microsoft Excel experience is required.

Education Required:

• High School Diploma required, Associate Degree preferred.

​

Sentara Benefits:

We are setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. Sentara offers exciting benefits including:

• Educational assistance up to $5,250 annually
• Medbridge access for CEUs and patient home programs
• Sentara hosted education courses with employee discounts
• Financial support for certifications
• Generous student debt program (no work commitment required)
• Relocation assistance
• Referral bonus program up to $10,000
• Up to 23 days of paid time off (incudes personal, vacation and holidays); Up to 5 sick days annually (based on 40-hour work week); bereavement leave
• 403(B) with immediate company match, upon hire!
• 401(A): 3% of annual salary employer contribution (participating divisions)
• Adoption benefits up to $10,000
• Fertility benefits (procedures/medications/IVF) and Surrogacy/Gestational Carrier benefits up to $10,000 combined
• 4 weeks paid parental leave; caregiver leave up to 2 weeks
• Paid life insurance (1 times annual salary), short-term and long-term disability
• Other benefits include medical, dental, vision, auto, home, travel, pet insurance, local gym discounts
• Wellness programs to include an employee assistance program (mental health support)

For more information about our employee benefits click Benefits – Sentara (sentaracareers.com) 

Join our team! Be a part of an excellent healthcare organization who cares about People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve! The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years.

For applicants within Maryland and Washington State, the following hiring range will be applied: $20.96/hr. – $25.15/hr. – $30.17/hr.

Keywords: Credentialing, Credentials, Certified Provider Credentialing Specialist, ​Data Entry, Medical Staff, Echo Database, Customer Service, Talroo-Allied Health

Job SummaryConducts data gathering, verification and analysis of practitioner applications and credentials for medical staff and affiliate appointment and privileges through both the Initial and Reappointment Application process. Responsible for maintaining all credentials files either in paper or electronic format, and maintains data in system-wide database.

Associates degree preferred. A minimum of 3 years of Medical Staff Office or Credentialing Office experience required in a hospital, health plan or CVO environment. CPCS – Certified Provider Credentialing Specialist preferred. Proficiencies in Echo database management preferred.

Qualifications:HS – High School Grad or EquivalentRelated experience

SkillsCommunication, Judgment and Decision Making, Microsoft Excel, Microsoft Word, Social Perceptiveness, Speaking, Technology/Computer, Writing

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

Billing & Posting Resolution Representative

by Irma Moore | Mar 11, 2025 | Uncategorized

Job Summary:

The Billing & Posting Resolution Representative position is responsible for acting as a liaison for hospitals and clinics using TruBridge Accounts Receivable Management Services. They work closely with TruBridge management and hospital employees in receiving, preparing and posting of receipts for hospital services while ensuring the accuracy in the posting of the receipt, contractual allowance and other remittance amounts. Candidates must be detail oriented with excellent verbal and written communication skills, organizational skills, and time management skills.

Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include:

• Receives daily receipts that have been balanced and stamped for deposit and verifies receipt total.
• Research receipts that are not clearly marked for posting.
• Post payments to the appropriate account and makes notes required for follow-up.
• Posts zero payments to the appropriate account and makes notes required for follow-up.
• Maintains log of daily receipts and contractual posted.
• Processes rejections by either making accounts private or correcting any billing error and resubmitting claims to third-party insurance carriers.
• Responsible for consistently meeting production and quality assurance standards.
• Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer.
• Updates job knowledge by participating in company offered education opportunities.
• Protects customer information by keeping all information confidential.
• Processes miscellaneous paperwork.
• Ability to work with high profile customers with difficult processes.
• May regularly be asked to help with team projects.
• 3 years hospital payment posting, including time outside Trubridge.
• Display a detailed understanding of CAS codes.
• Post denials to patient accounts with the correct denial reason code.
• Post patient payments, electronic insurance payments, and manual insurance payments.
• Balance all payments and contractual daily.
• Make sure postings balance to the site’s bank deposit.
• Adhere to site specific productivity requirements outlined by management.
• Serve as a resource for other receipting service specialists.
• Must be agile and able to easily shift between tasks.
• May require overtime as needed to ensure the day/month are fully balanced and closed.
• Assist with backlog receipting projects, such as unresolved situations in Thrive, researching credit accounts, and reconciling unapplied.

Minimum Requirements:

Education/Experience/Certification Requirements

• 3 years hospital payment posting, including time outside TruBridge.
• Computer skills.
• Experience in CPT and ICD-10 coding.
• Familiarity with medical terminology.
• Ability to communicate with various insurance payers.
• Experience in filing claim appeals with insurance companies to ensure maximum reimbursement.
• Responsible use of confidential information.
• Strong written and verbal skills.
• Ability to multi-task.

Why join our team?

• Work remotely with a work/life balance approach
• Robust benefits offering, including 401(k)
• Generous time off allotments
• 10 paid holidays annually
• Employer-paid short term disability and life insurance
• Paid Parental Leave

Risk Adjustment Coder

by Irma Moore | Mar 11, 2025 | Uncategorized

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

**CPC or CSS Certification and (2) years direct coding experience required**

Position Purpose: Coders will work daily reviewing medical records abstracting any HCCs that are able to be validated.  

• Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-10). Always coding to the highest level of specificity.
• Follows the Official ICD-10 guidelines for Coding and Reporting and has a complete understanding of these guidelines.
• Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines.
• Understands the impact of ICD-10 codes on the CMS HCC risk adjustment model.
• Ability to meet productivity and accuracy standards
• Ability to defend coding decisions to both internal and external audits.
• Complies with all policies and standards

Education/Experience: Required A High School or GED

Preferred: Bachelor’s Degree in a related field:
Candidate Experience: Required 2+ years of experience in professional coding experience either in a hospital or physician setting

Licenses and Certifications: A license in one of the following is required:
Certified Professional Coder (CPC)
Certified Coding Specialist (CCS)Pay Range: $22.79 – $38.84 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Quality Reporting Data Analyst (Healthcare)-SAS Programming

by Irma Moore | Mar 11, 2025 | Uncategorized

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. This position contributes to quality improvement efforts through the research, analysis, design, programming, implementation and coordination of accurate and timely reporting. The incumbent will partner with multiple customers across the Enterprise to provide complex resolutions to analytics/data problems and will provide reporting/analytic deliverables (i.e. tables, graphs, recommendations, etc.) in a consultative manner. Incumbent is responsible for conducting research and root cause analysis for customers with the goal of recommending and implementing new processes and solutions to operational deficiencies. This is a senior level position working independently with guidance only in the most complex situations.

Responsibilities:

• Analyzes reporting needs, available data, and various methods of data retrieval to develop systems which are responsive to the needs of the department.
• Develops and maintain production reporting capabilities. Monitor the timely and accurate production and distribution of all standard and special user-generated reports.
• Provides statistical and analytical support to the department staff. Utilizes SAS, SQL, SOURCE and other statistical based software packages to extract and analyze the data required by the department for both continuing and special needs.
• Facilitate business requirements and define parameters of more complex analytic projects
• Research and investigate key business problems through quantitative analyses of healthcare cost and quality data.
• Analyze data results from multiple information sources to ensure reporting and analytic requirements are met.
• Develop forecasting tools using current technology/systems.
• Translate business requirements and assist IT with the development of technical specifications.
• Lead or participate in internal and external project workgroup(s) and presentations.
• Conduct User Acceptance Testing (UAT) for projects, implementations, system fixes and enhancements, etc.
• Prepare materials for internal and external audit activities; review audit findings/reports for accuracy and completeness.
• If appropriate, formulate rebuttal and/or corrective action steps. Coach/mentor less experienced staff, assist in on-boarding of new staff and/or distribute and follow-up on work assignments.

Education/Experience:

• Bachelor’s degree in a Quantitative Field (i.e. Analytics, Economics, mathematics, Computer Science, Engineering, Public Health, Nursing ) preferred or relevant work experience in lieu of degree.
• Managed health care or provider experience preferred, especially in roles that routinely have used clinical data sources to support quality management operations.
• 3-5 years of experience; conducting complex analytics deliverables (i.e. linear models and more advanced independent analytics).

Knowledge:

• Requires proficiency with very large data sets and software/coding (i.e. SAS). Requires proficiency in MS Office (particularly Excel including formulas, calculations and graphs).
• SAS/SQL experience strongly preferred.
• HEDIS knowledge/experience strongly preferred.

Skills and Abilities:

• Requires analytical thinking ability.
• Good written and verbal communication skills are essential. Ability to express analytic thoughts clearly and concisely both verbally and in writing (to various audiences) is required. Requires strong interpersonal skills and the ability to interact with all management levels. Require ability to make decisions to analytic/data problems that synthesize information from several sources into concrete actions/recommendations for higher level audience.
• Requires the ability to utilize logic in problem solving. Requires the ability to coordinate projects. Requires the ability to translate business objectives into technical solutions.

Travel:

• Some travel to the Newark and Hopewell locations.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:$86,000 – $117,390

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.  Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.