Data Analyst Sr, Finance - Encounter Data - Covered California

About the role

The Data Analyst Sr, Finance - Encounter Data - Covered California position is open at Encounter Data, part of CalOptima Health. This role is part-time telework eligible and requires working at least two days per week in Orange, CA. The position supports the data reporting responsibilities of the Encounters team within the Finance department.

Responsibilities

• Maintain current Encounter tasks, including monitoring and reviewing 5010 837 files submissions.
• Create and maintain Standard Query Language (SQL) queries to reconcile data for new projects, including submission testing with vendors for DHCS and CMS.
• Ensure timely, complete, and accurate data submissions inbound and outbound with the IT team.
• Support the Encounter team with the maintenance of data through SQL tables.
• Work with other departments to ensure complete and accurate data processing, including coordination with EDI for Encounter Data issues.
• Coordinate with Claims Administration and IT teams to improve encounter data submissions.
• Reconcile data in SQL tables through various processes of the Encounters Submission.
• Analyze members, providers, encounters, and claims data to prepare and review analytics methods.
• Create detailed business requirements for technical programs, including implementation of new processing platforms.
• Establish and maintain strong working relationships with delegated health networks.
• Stay current on DHCS, CMS, and Covered California data reporting requirements and report on any changes affecting CalOptima Health and health networks.
• Refer complex data integrity issues to the manager for further evaluation and action.

Requirements

• 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.
• Equivalent combination of education and experience may also qualify.
• 4 years of experience in an IPA, hospital, or health plan setting.
• 4 years of experience with managed health care programs.
• 1 year of experience with submissions to Covered California.

What the Regulatory Agencies Need You to Possess

N/A

Knowledge & Abilities

• Develop rapport and establish effective working relationships with CalOptima Health's leadership and staff and external contacts.
• Communicate clearly and concisely, both orally and in writing.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint).

Physical Requirements

• 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.
• Ability to hear 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 up to 25 pounds.

Ways We Are Here For You

• Competitive compensation
• Comprehensive benefits package including CalPERS pension program and additional retirement packages
• A generous PTO program
• Variety of wellness programs
• Tuition reimbursement
• Professional and career development opportunities
• Flexible scheduling

Our Work Environment

• Indoors, sedentary, subject to schedule changes and/or variable work hours, with travel as needed.
• Indoors in a clinical setting serving the frail and elderly, with potentially harmful or hazardous environmental conditions.
• Indoors and sedentary, subject to schedule changes and/or variable work hours, with travel as needed.
• Indoor and sedentary, subject to schedule changes and/or variable work hours, with travel as needed.

Why Join Us

We believe in diversity and inclusion, reflecting and representing the communities we serve. We welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

Next Steps

To apply, please visit: https://jobs.caloptima.org/jobs/data-analyst-sr-finance-encounter-data-covered-california-505-city-parkway-west-california-united-states