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Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance
The Healthcare Finance (HCF) department exists to monitor and improve the financial performance of Kelsey-Seybold’s (KS) product lines and health plans. The HCF Analytics team is a customer service-focused department providing consultation to the KS executive team as well as to select operational and functional departments. The HCF Analytics team works closely with internal and external partners to identify revenue and cost savings opportunities, support new product and business development, ensure regulatory compliance, inform contract negotiations and complete reconciliation of incentive arrangements, claims, capitation, and premium payments with other payers, vendors and/or government entities. The HCF department is adequately staffed by highly skilled, motivated and inquisitive individuals that deliver complex analysis of financial and utilization data to support revenue enhancement and identify cost savings opportunities.
The Senior Analyst will provide data, systems support, and analysis related to risk adjustment and quality data submissions. The team operates the CMS Encounter Data and HEDIS vendor software solutions and implements reporting and analysis specific to Medicare risk adjustment, RAPS, EDPS and HEDIS. The team analyzes and researches all encounter data errors and submission issues, collaborating with internal departments to work toward error resolution. The Senior Analyst is able to independently identify areas requiring investigation, define and perform analyses, and recommend solutions with little to no guidance.
Key responsibilities of this position include:
• Encounter Data Analyst: Creating submissions and evaluating encounter data to identify errors created by operational, claims, and eligibility processes. Working with cross-functional teams to resolve errors and ensure completeness and accuracy of submissions.
• HEDIS/Quality Reporting Analyst: Mapping, verifying, and loading HEDIS data sources to calculate measure results and prepare member level detail to support audited reporting and quality improvement initiatives.
• System Support Analyst: Helping to develop and maintain the systems and processes that are the foundation of risk adjustment and quality data operations
• Report Writer: Developing, producing, and analyzing reports and data required to understand submission status and rejection issues related to risk adjustment and quality data submissions
• Acting as a subject matter and technical expert for more junior analysts.
Senior Data Operations Analyst
Location: Pearland Administative Office
Department: KS Plan Advantage – Health Care
Job Type: Full Time
Salary Range: $89,706.40-$117,739.65
(Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Required: Bachelor’s Degree in Finance, Economics, Mathematics, Healthcare Administration, Computer Science or related field
Required: 5+years of experience in data analysis, decision support, medical economics, healthcare informatics, or managed healthcare or equivalent combination of education and experience to demonstrate ability to succeed in data operations. Demonstrated initiative and problem-solving skills with ability to convert raw data into actionable business insights. Demonstrated data extract and transformation skills
Preferred: Experience in the healthcare industry with understanding of data in healthcare organizations (including claims data, ICD10, Medicare Advantage, Health Insurance Marketplace, capitated payment models). Experience with ANSI 5010 837 data specifications.
Required: Advanced proficiency in Microsoft Excel. 3+ years’ experience with SQL or other programming tools (including Visual Basic and Excel macros). Experience writing, debugging and documenting complex queries against relational databases. Basic knowledge of Microsoft Power Point and Microsoft Word.
Preferred: Familiarity with EPIC and Clarity reporting data warehouse. Knowledge of Crystal Reports, Microsoft Access, or SSRS.
Required: Fluent in English both verbal and written, effective communicator. High level of accuracy with excellent attention to detail. Strong organizational and time management skills. Proven ability to work in a dynamic setting and balance multiple priorities while meeting deadlines. Superior analytical skills. Ability to communicate complex information in a clear and concise manner
Working Environment: Office