Compliance Data Analyst
This position is responsible for a range of auditing and monitoring duties, including the analysis and review of operational controls and business processes for adherence with State and Federal requirements and PrimeWest Health policies, procedures, and standards.
The Compliance Data Analyst conducts such analyses using a wide variety of data, develops conclusions, and provides recommendations to management. The position applies analytical, conceptual, and logic skills to business concepts and develops them into operational methods. In addition, the Compliance Data Analyst is responsible for encounter accuracy, timeliness, and completeness, and for assisting in the review of regulatory and system notifications and encounter data processing exceptions from the Centers for Medicare & Medicaid Services (CMS) and the Minnesota Department of Human Services (DHS).
Educational Requirements and Required Qualifications*
At minimum, two years of post-high school education in business or a field of study related to health care and/or claims administration; may substitute experience in health care billing or claims payment administration on a year-for-year basis. Two or more years of health care claims or claims-related experience in a position with a health care claims payer organization or provider billing environment preferred.
* Experience conducting internal/external audits or compliance reviews is preferred
* Knowledge and understanding of common health care claim code sets, including, but not limited to, CPT, HCPCS, and ICD-10
* Ability to independently research and troubleshoot
* Demonstrated project management skills
* Ability to efficiently navigate the Internet, as well as navigate PrimeWest Health applications or systems
* Demonstrated knowledge of, and proficiency in, Word, Excel (including developing and using formulas, pivot tables, VLOOKUP functions, charts, etc.), and Outlook required. Use of other applications as needed.
* Effective conflict resolution, problem-solving, analytical, and negotiating skills
* Ability to work effectively with a variety of people both within and outside of the organization. Excellent verbal and written communication skills.
* Willingness to work hours necessary to successfully accomplish assigned tasks in a timely manner
* Willingness to learn new skills as may be required by the position
* Ability to sit at a desk or computer station most of the time. Ability to occasionally lift and/or carry such articles as file folders and small boxes up to 25 pounds. Infrequent travel may be required.
PrimeWest Health will accept resumes until position is filled. No phone inquiries please. Employment to begin as soon as possible.