Data Analyst, Sr. (Finance ‐ Encounter Data)
CalOptima
CalOptima Health is seeking a highly motivated Data Analyst Sr (Finance ‐ Encounter Data) to join our team. The Data Analyst Sr (Finance ‐ Encounter Data) will support the data reporting responsibilities of the Encounters team within the Finance department. The incumbent will support with the maintenance of current Encounter tasks, such as monitoring and reviewing the 5010 837 files submissions. The incumbent will create and maintain Standard Query Language (SQL) queries to reconcile data for new projects, such as submission testing with vendors for the outbound process with the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) and to continually improve data acquisition and reporting methods. The incumbent will ensure timely, complete and accurate data submissions inbound and outbound with the Information Technology (IT) team.
Position Information :
- Department : FIN ‐ Encounters
- Salary Grade : 312 ‐ $84,092 ‐ $134,548 ($40.43 ‐ $64.6865)
- Work Arrangement : Full Telework
- This position is eligible for telework in California.
Duties & Responsibilities :
95% ‐ Program SupportParticipates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals / priorities for the department.Supports the Encounter team with the maintenance of data through SQL tables.Works with other departments to ensure complete and accurate data is being processed appropriately, which impacts DHCS and CMS, such as coordinating with Electronic Data Interchange (EDI) on any technical assistance for Encounter Data issues for 5010 837 data submissions.Coordinates with Claims Administration and IT teams to work with on improving encounter data submissions.Assists with reconciling data in the SQL tables through the many processes of the Encounters Submission.Provides expertise in data analysis, including members, providers, encounters and claims data.Prepares and reviews analytics methods to verify data integrity of claims and inbound 837 encounters.Creates detailed business requirements for technical programs, including implementation of new processing platforms for new and existing vendors.Interacts with existing delegated health networks to establish and maintain strong working relationships.Stays current on the DHCS and CMS data reporting requirements and reports on any changes that affect CalOptima Health and / or health networks.Refers complex data integrity issues to the manager for further evaluation and action as needed.5% ‐ OtherCompletes other projects and duties as assigned.
Minimum Qualifications :
Bachelor's degree in health care administration, business administration, mathematics or related field PLUS 5 years of experience as a Data Analyst creating and maintaining SQL queries and improving reporting methods required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.Preferred Qualifications :
4 years of experience in an Independent Physician Association (IPA), hospital or health plan setting.4 years of experience with managed health care programs.Required Licensure / Certifications :
N / AKnowledge & Abilities :
Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.Work independently and exercise sound judgment.Communicate clearly and concisely, both orally and in writing.Work a flexible schedule; available to participate in evening and weekend events.Organize, be analytical, problem‐solve and possess project management skills.Work in a fast‐paced environment and in an efficient manner.Manage multiple projects and identify opportunities for internal and external collaboration.Motivate and lead multi‐program teams and external committees / coalitions.Utilize computer and appropriate software (e.g., Microsoft Office : Word, Outlook, Excel, PowerPoint) and job specific applications / systems to produce correspondence, charts, spreadsheets, and / or other information applicable to the position assignment.Physical Requirements (With or Without Accommodations) :
Ability to visually read information from computer screens, forms and other printed materials and information.Ability to speak (enunciate) clearly in conversation and general communication.Hearing ability for verbal communication / conversation / responses via telephone, telephone systems, and face‐to‐face interactions.Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.Lifting and moving objects, patients and / or equipment 10 to 25 poundsWork Environment :
If located at the 500, 505 Building or a remote work location :
Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.There are no harmful environmental conditions present for this job.The noise level in this work environment is usually moderate.If located at PACE :
Work is typically indoors in a clinical setting serving the frail and elderly.There may be harmful or hazardous environmental conditions present for this job.The noise level in this work environment is usually moderate to loud.If located in the Community :
Work is typically indoors and sedentary and is subject to schedule changes and / or variable work hours, with travel as needed.Employee will occasionally work outdoors in varied temperatures.There may be harmful or hazardous environmental conditions present for this job.The noise level in this work environment is usually moderate to loud.About CalOptima Health :
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto ‐ "Better. Together." ‐ is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. Cal
