Senior Healthcare Analyst
# Senior Healthcare Analyst **RPAutomation Inc.** · Quincy, MA 02171 · `On-site` 🕒 **Статус:** *Опубликовано: 19 дней назад* · *Источник: Indeed* --- ### About the Role Chloen Systems Inc. We are seeking a highly skilled and experienced Senior Healthcare Analyst to join our large-scale Healthcare claims systems and processing team. As a Senior Analyst, you will be responsible for analyzing complex data sets, identifying trends, and providing valuable insights to drive strategic decision-making. This role requires strong technical skills, attention to detail, and the ability to effectively communicate findings to stakeholders. Specifically, the position requires the candidate to be able to take various claims-based data requests and produce focused adjudication reports, often encompassing multiple facets of both prior and destination payer activity. Must be able to work with multiple individuals and obtain specifications to produce the final reports while understanding the technical constraints of the current business process and timing. Attention to detail is necessary to ensure appropriate request delivery as well as efficiency due to the ad hoc nature of requests. Duties: - Collect and analyze data from various sources to identify patterns, trends, and insights - Use SQL and other data analysis tools to manipulate and extract data - Conduct data mining and data management activities - Collaborate with cross-functional teams to define business requirements and develop solutions - Design and implement systems for data collection, storage, and reporting - Create reports and visualizations to present findings in a clear and concise manner - Stay up-to-date with industry trends and best practices in data analysis Experience: - Bachelor's degree in IT, Computer Science, or related field; master’s degree preferred - Proven experience as a Senior Analyst or similar role - Strong knowledge of SQL and experience working with databases - 7-10 years experience reviewing and interpreting 3rd party adjudication of hospital institutional and professional HIPAA 837 claims for denial resolution or additional collections - Required knowledge of the 837 envelope/loop/segment format for identifying adjudication details from billing details - Understands hospital revenue cycle and various billing release schedules - Has working knowledge of the Claim Adjustment Reason Codes and corresponding Remit Advice Remark Codes - Has experience calculating expected reimbursement from commercial, private, and various government payers - Has experience with determining payer sequence for appropriate collections in a timely manner - Has completed government payer Credit Balance reporting for audit - Has knowledge of ICD10-CM and -PCS as well as CPTs, HCPCS, and Modifiers - Has knowledge of inpatient payment methodologies that follow Cost-to-Charge vs. Grouper pricing for DRGs (specifically MS-DRGs) - Has knowledge of Professional Services FFS pricing and Outpatient Institutional Visit Rate calculation pricing - Solid understanding of data collection, analysis, and reporting techniques - Familiarity with medical terminology and healthcare industry standards - Ability to design system architectures for data analysis and reporting purposes - Preference given to candidates who come from the provider side of claims processing Technical Qualifications - Five plus years of MS SQL Server Transact SQL via Microsoft SQL Server Management Studio (SSMS). - Able to produce analytics without an analytic data layer over the core databases - Proficient in Microsoft Word, Excel, PowerPoint, Visio, SharePoint - Familiarity with medical terminology and healthcare industry standards Location Hybrid position that can commute occasionally to Boston for Meetings. Interviews will be done by video conference and in person with deep technical exercises. Background Check There will be extensive background checks as the position has access to sensitive PHI. There will also be an extensive check of documentation and references. Benefits: Competitive contract rate based on experience Job Type: Contract Pay: $75,500.00 - $129,500.00 per year Benefits: Flexible schedule Experience: healthcare analytics : 5 years (Preferred) License/Certification: Reporting writing skills with massive data sets (Required) ICD10-CM, PCS, CPT's HCPCS, DRG's (Required) Work Location: Hybrid remote in Quincy, MA 02171
Наблюдалась 2026-09-15, впервые 2026-08-28, источник — Indeed.