Job Description:
• Joining a collaborative cross functional team with representatives across the organization to enhance and support payer products and services
• Working with subject matter experts, defining business requirements, standard business rules, and producing documentation that is client-facing as well as technical documentation used by developers
• Performing data analysis and reviewing business rules with business stakeholders to refine product requirements
• Validating results from development teams for implementation of business rules and business requirements
• Presenting standard product capabilities to support product implementation and post implementation lifecycles
Requirements:
• Bachelor’s Degree or higher from an accredited university AND eight (8) experience in Healthcare Information Technology.
• OR High School Diploma/GED AND a minimum of twelve (12) years of experience in Healthcare Information Technology.
• Six (6) years of experience working in the Healthcare industry, preferably with data analytic experience of commercial, Medicaid and/or Medicare health plans.
• Strong knowledge in claim analytics, billing, member eligibility, provider data, and quality reports.
• Six (6) years of experience performing requirements gathering and analysis.
• Six (6) years of experience in writing SQL queries for large data warehouses.
• Five (5) years in an analyst role documenting business rules and source to target mapping.
• Additional qualifications that could help you succeed even further in this role include: Experience with provider-level data, clinical data management, and working within Microsoft SQL Server environments.
• Familiarity with data warehousing and business intelligence terminology, along with experience collaborating with ETL developers, BI architects, and report developers to communicate data mapping.
• Experience working within an agile development organization.
• Understanding of MS-DRG and APC, as well as proprietary Solventum methodologies, including APR DRG, EAPG, CRG, PPR, PPC, AM-PPC, PFP, and PFE.
• Familiarity with statistical methods and models to provide analytic and methodology guidance, along with demonstrating a sense of urgency, ownership, results orientation, and a growth mindset supporting healthcare payment innovation, patient safety, efficiency, quality of care, and value-based care efforts.
Benefits:
• Medical, Dental & Vision
• Health Savings Accounts
• Health Care & Dependent Care Flexible Spending Accounts
• Disability Benefits
• Life Insurance
• Voluntary Benefits
• Paid Absences
• Retirement Benefits