Overview
Skills
Job Details
Technical Analyst - Revenue Cycle and Claims or Population Health
Notes: Mandatory Advanced level SQL Proficiency
Candidates must demonstrate proficiency in the following:
• Common Table Expressions (CTEs): Using the WITH clause to break down a complex query into smaller, readable, and reusable blocks.
• Subqueries: Proficiency in using nested SELECT statements (in the FROM, WHERE, and SELECT clauses) and knowing when to use them versus a JOIN.
• Advanced Joins: Deep understanding of all join types (INNER, LEFT, RIGHT, FULL), and the ability to join multiple tables (5+) correctly.
• Set Operations: Using UNION, UNION ALL, INTERSECT, and EXCEPT to combine results from multiple queries.
• Conditional Logic: Extensive use of the CASE statement for complex data categorization, pivoting, and transforming data based on business rules.
Job Summary
• Works with stakeholders to discover, clarify, and document current and future data needs
• Performs mapping of revenue cycle, clinical and claims data to a normalized data model.
• Serves as a subject matter expert on the revenue cycle data domains such as Registration, Scheduling, Accounting and Billing, Cost Accounting and Claims
• Builds data concepts to support Revenue Cycle and Claims use cases
• Serves as a key resource for an assigned customer area to understand and explain business and technical issues and to provide viable technology solutions.
Responsibilities:
• Act as a quality consultant and subject matter expert, performing testing and validation of the mapping of data elements to standards
• Collaborates with technical resources to perform root cause analysis and complete remediation of data quality issues
• Works with customers to clarify and plan for their current and future technology needs. Determines and maps existing business processes/functions and recommends changes required to fit a tightly integrated system.
• Designs and implements projects requiring systems integration, small teams and multiple technical platforms.
• Conducts Return on Investment (ROI) and other financial analysis to support project funding/prioritization.
• Collaborates on driving improvement activities to achieve department and organizational goals.
• Coordinates with functional team to assure consistency and optimization of overall work product
• Assumes a proactive role in driving improvement activities to achieve department and organizational goals to deliver value.
• Maintains current knowledge of industry and business process trends and is able to apply that knowledge to existing business processes.
• Provides subject-matter expertise of Health Ministry processes, policies and requirements in support of functional area process design, testing and implementation
• Identifies opportunities for process improvement and makes recommendations that lead to improvements
• Monitors task assignments to ensure they are performed on schedule, within intended scope and to a defined level of quality.
• Escalates process and project issues that cannot be resolved
Experience:
• Prior experience working as a Revenue Cycle analyst in the Healthcare system.
• Must have a working knowledge of relational databases/database structures, SQL expertise desired
• Must have a strong understanding of data collected and used in EMRs, Revenue Cycle and Patient Accounting Systems.
• Knowledge and experience with ambulatory and acute clinical, billing and claims workflows and clinical information systems.
• Bachelor or Masters degree in related health or finance field ex informatics or bioinformatics.
• Complexity of work: Within the scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment.
• 5 years of experience preferred