1. Own, monitor, audit, and perform remediation activities for various department systems. Analyst role grants and monitors user access level rights in the following applications/systems: (ie: NetDocs, Sharepoint and Intellisoft).
a. Analyze data, develop audit processes, and provide system and remediation recommendations, as required, to ensure data integrations, workflow process and compliance meet all business unit(s) requirements.
b. Identify risk concerns and prepare monthly KPI metric reports for executive review.
c. Manage, maintain, and track various departments and team project board(s) and associated projects to ensure all projects remain on track
d. Ensure compliance with SOPs and reports any inherent risks, potential exposures and attenuating controls
e. Ensure all SOPs accurately depict the workflow and processes and provide recommendations related to system or data elements to enhance processes when applicable.
f. Develop and maintain the department’s management dashboard through various CRM’s (ie: salesforce, intellisoft, athena, sharepoint) applications by creating/developing reports that depict the indicators for department health.
2. Responsible for Quality Assurance related activities relative to medical records or any departmental PHI in accordance with state regulations and HIPAA compliance.
a. Audit data periodically to ensure error rate is managed within acceptable guidelines and make recommendations as needed. Remediate compliance issues as needed.
b. Identify and implement continuous improvement processes and tools to enhance data quality and integrity across systems.
c. Receive, tabulate and report on complex and confidential data elements on various program adherence and satisfaction. Report outliers and/or risk to executive department management and/or company compliance officer.
d. Develop and periodically audit various data and process criteria to support the management of multiple divisions within the insurance service department.
e. Refine and manage audit and quality checks providing specified reporting to team management.
f. Track, trends and report any egregious quality and/or compliance issues to department director and company compliance officer.
3. Manage data acquisition and important processes across multiple points of entry and systems, specifically Salesforce.com (classic and lightening), NetDocs (document repository), Intellisoft (credentialing), Athena, SharePoint to ensure integrity of data used for business recommendations, process, output, and workflow.
a. Review output from various systems to identify data errors, research cause and work with IT or department leads in the identification and resolution.
b. Conduct aggregate analysis on large data sets using excel
c. Evaluate data trends to ensure data meets healthcare industry standards.
d. Audit and maintain automated processes for several systems and workflows and identify resolutions.
e. Improve, maintain, and execute data and system clean-up, standardization, or improvement projects.
4. Identify and report relevant quantitative Data Quality Metrics to stakeholders and department management/leadership, using various systems to acquire data and provide in a consistent data format to power dashboards and reports.
a. Consult with stakeholders to determine data-related needs and generates data specific reports to meet business analysis requirements.
This job profile is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Bachelor’s degree required along with a minimum of 5 years related experience. The equivalent combination of education and experience where two years related experience equals one year of schooling is highly desirable. Related experience assumes a similar corporate role focused on business and data analysis and data quality metrics.
· Strong understanding of financial and accounting principles a plus.
· Experience with SQL or Python (preferred but not required)