Healthcare Data Analyst (Claims Admin, Facets)

Healthcare Data Analyst (Claims Admin, Facets) needs Facets, 5 years of experience working within a core claims administration system.

Healthcare Data Analyst (Claims Admin, Facets) requires:

• Good analytical and problem-solving skills

• A minimum of 2 years’ experience writing SQL queries and exporting data from database tables.

• Ability to manage multiple complex assignments at once

• 3+ years’ experience in Operations in the Healthcare industry

• Experience understanding claim adjudication for member and provider reimbursements.

• Experience with Facets platform using Claims, Provider, Network, Product Benefit Configuration

• Knowledge of Medicare and Medicaid programs

• SQL and Database experience

Healthcare Data Analyst (Claims Admin, Facets) duties:

• Write SQL queries to extract data from the database, analysis of configuration data to identify clean-up activities.

• Ensure agreement configuration accuracy that may impact provider payment and member responsibility.

• Set up new Network and Agreement configurations into the Facets system.

• Validate agreement and network configuration utilizing claims testing, SQL queries and Excel to ensure the configuration properly adjudicates during claims processing, for member benefit, reimbursements and provider pay amounts.

• Perform and resolve network and agreement configuration questions/issues sent to the Business Configuration team without guidance.

• Support the management team with on-going training activities, misc. projects, resolving issues, and serving as a subject matter expert for all Configuration requests.