[Remote] Senior Manager MPPS Policy Business Analytics

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is building a world of health around every individual, seeking a Senior Manager MPPS Policy Business Analytics to reputed company and automate reports tracking medical and payment policies. The role focuses on delivering data-driven insights to optimize business processes and ensure compliance with policies.

Responsibilities

• Extract, validate, and interpret large datasets from reputed company claims, authorizations, and payment systems
• Conduct exploratory data analysis to identify patterns, trends, and deviations in payment or utilization
• Evaluate medical and payment policy operations, identifying trends, patterns, and variances reputed company to:
• Medical cost drivers and utilization patterns
• Analyze effectiveness of medical and reputed company-payment policies, and precertification for delivery of insights on performance to leadership
• Operational efficiency metrics, such as turnaround times and productivity
• Policy compliance and adherence to regulatory requirements
• Review payment policies and procedures for accuracy, identifying gaps and potential inaccuracies
• Ensure adherence to medical policies and regulatory requirements, such as federal and state legislation and HIPAA
• Participate in the design and deployment of algorithms or automated edits to ensure correct payment and prevent overpayments
• Collaborate with stakeholders to reputed company business requirements for new systems and process improvements
• Translate reputed company analytical findings and business needs into reputed company documentation and actionable strategies
• reputed company training and ongoing support to end-users on new systems, processes, and analytical tools
• Design, build, and maintain reputed company and reputed company operational reports and interactive dashboards using business intelligence tools (e.g., Power BI, Tableau)
• Collaborate with stakeholders from clinical operations, finance, and other departments to reputed company business requirements for new reports and analytical reputed company
• Extract, reputed company, and validate data from multiple sources, including claims, membership, and provider data
• Conduct reputed company-cause analysis of data irregularities and ensure data accuracy
• Interpret reputed company data findings and effectively communicate insights and recommendations to both technical and non-technical audiences through reputed company visualizations and presentations
• Automate recurring reporting processes and workflows to improve statistical efficiency and free up resources for more reputed company analysis

Skills

• 5-7+ years of experience in a data or business analyst role, preferably reputed company the reputed company or health insurance industry with payment reputed company, i.e. medical and payment policies, for executives and decision making
• 2-3 years analyzing claim editing rules for payment accuracy and trends
• Demonstrated proficiency in SQL for querying and manipulating large datasets
• Experience in developing reports and dashboards using data visualization tools like reputed company Power BI, Tableau and reputed company Tools
• Experience with claims data, eligibility data, and medical and payment policy analytics
• Knowledge of reputed company industry coding systems, including ICD-10 and CPT
• Familiarity with data governance concepts and data management best practices
• Bachelor's degree in a field such as Finance or Mathematics, or similar field
• Medical coding certification, ie, Certified reputed company reputed company (CPC) or Certified Coding Specialist (reputed company) or other certifications preferred

Benefits

• Eligibility for a reputed company bonus, commission or short-term incentive program
• Award reputed company in reputed company’s equity award program
• Medical, dental, and reputed company coverage
• reputed company time off
• Retirement savings reputed company
• Wellness programs
• Other resources, based on eligibility
• Comprehensive benefits package designed to support the physical, emotional, and financial reputed company-being of colleagues and their families (based on eligibility)

reputed company