Healthcare Analyst lll
First Choice Health
On-site
Seattle, Washington, United States
$80,000 - $107,000 USD yearly
Healthcare Analyst
POSITION SUMMARY:
This position is responsible for: (1) tracking and auditing stop loss claim submissions to ensure they are accurate and done in a timely manner. (2) ensure standard monthly stop loss reporting is accurate and provided in a timely manner. and (3) be an advocate for the stop loss processes and create transparency of any concerns to the various departments, such as the Account Executive, Claims and Medical Management team.
This position will be responsible for producing ad hoc reports and analysis to support the stop loss processes for internal and external needs as well as other non-stop loss related ad hoc,analysis and project work to support the overall objectives of the HCA team .
As a part of a small team in a dynamic company, this person is expected to be a self-starter who has demonstrated the ability to quickly and independently learn how to use software tools and healthcare data as required.. He/she should be comfortable working within a team and independently with internal customers, such as the Account Executive Team, to ensure stop loss requirements and ad hoc requests meet requirements.
This position will be responsible for producing ad hoc reports and analysis to support the stop loss processes for internal and external needs as well as other non-stop loss related ad hoc,analysis and project work to support the overall objectives of the HCA team .
As a part of a small team in a dynamic company, this person is expected to be a self-starter who has demonstrated the ability to quickly and independently learn how to use software tools and healthcare data as required.. He/she should be comfortable working within a team and independently with internal customers, such as the Account Executive Team, to ensure stop loss requirements and ad hoc requests meet requirements.
EXAMPLES OF DUTIES:
- Learn reinsurance practices, interpret our client’s stop loss contracts, FCH claims processing and related Medical Management activities
- Responsible for collecting and understanding stop loss contracts and maintaining related internal tables of these terms used for automation & reporting and developing solutions to unique contract terms or timeframes. E.g. applying non-FCHA claims
- Peer review the SL analyst’s submissions & standard monthly/renewal reporting
- Be an internal advocate for Stop Loss submission requirements and issues, working with other departments as needed.
- Work with HCA team members or other departments (e.g. BAT, Claims, IT) for any tool and process improvements
- Create transparency across departments on stop loss activity using Stop Loss committee or other means
- Develop ad-hoc reporting and analysis as required to support TPA clients/brokers.
- Audit and\or research data as it relates to healthcare analytics and our analytical vendors.
- Provide back-up and support to other team members.
- Other duties as assigned.
QUALIFICATIONS:
- Associate Degree minimum, Bachelor’s degree preferred in an analytic field such as Finance, Economics, Mathematics, or other related field, or equivalent experience.
- Strong analytical problems solving skills. Proven analytical experience working with healthcare claims data; or equivalent knowledge of healthcare data, and proven technical aptitude to quickly learn software tools to support needed data & analysis.
- Diligence to details, preference for mathematics or auditing background
- Ability to learn & understanding general reinsurance practices, our clients’ stop loss contracts, our claims processing systems and related Medical Management activities
- Ability to work with PHI and send secured electronic transfer of files.
- Strong written, verbal, analytical, and interpersonal skills. Willingness to ask questions when assigned a task.
- Ability to work independently and in a team in an organized manner to meet deadlines.
- Ability to react quickly to needs and priorities of internal and external clients.
- Comfortable with software applications such as GSuite or Microsoft products such as SHEETS or Excel.
- General understanding of relational databases and programming for reporting purposes. Experience in the AWS platform is preferred.
PHYSICAL REQUIREMENTS:
- Ability to sit for long periods of time.
- Ability to see and hear within normal ranges, with or without aids.
- Ability to speak clearly.
- Hand and finger dexterity within normal ranges.
Access to PHI:
- Routine & re-occurring access to all forms of PHI – The duties of the position require regular and unrestricted contact with PHI.
- Routine and limited and does not require manager approval - The duties of the position require routine contact with a limited set of PHI that does not require manager approval. Examples include claims adjudication.
- Restricted and limited to manager approval on an as needed basis – Access to PHI is flexible and limited to a need to know basis pre-determined by the manager/supervisor depending on the nature of the task to be performed by this position.
- Subject to incidental PHI disclosure – The position will at times come in contact with PHI that cannot be prevented, is limited in nature, and that occurs as a result of another permitted use or disclosure. Examples include proximity to areas where PHI is accessed or discussed.
- No PHI is accessed to perform the duties of the position – The position without exception has no job requirements involving the access to PHI.
Pay Range: $80,000.00 - $107,000.00
Diversity, Equity & Inclusion:
At First Choice Health we are thoughtful about the words we use and the actions we take. We intentionally hire people from diverse backgrounds that help us think differently and challenge status-quo thinking. Our commitment to Diversity, Equity, and Inclusion allow us to strive to make healthcare easier to access for everyone in all walks of life.
Benefits:
- Medical & Vision- We offer two medical plans for employees, High Deductible and PPO plan for employees to choose from.
- Dental- A dental plan through Sun Life dental is available to employees and eligible dependents.
- Health Savings Account (HSA)- Employees who enroll in our medical plan can choose to establish a health savings account if eligible. FCH makes contributions to the HSA and employees may contribute pre-tax dollars via payroll deduction up to the IRS allowable limits.
- Flexible Spending Account (FSA)- Employees may contribute pre-tax dollars through payroll deduction to a limited vision/dental FSA. Unlike with an HSA, unused FSA funds do not rollover from year to year
- Life Insurance- FCH provides life insurance benefits at no cost at a limit of two times an employee’s annual base salary (with a max of $300,000). Employees have the opportunity to purchase additional life insurance for themselves and their dependents through payroll deduction.
- Short & Long-Term Disability Insurance- FCH provides long-term and short-term disability coverage to all employees. It is a shared cost benefit where FCH pays for the long-term benefit and employees pay for the short-term benefit.
- Personal Leave and Sick Time- FCH employees enjoy the benefit of paid time off. Vacation, sick leave, and any personal leave are combined into a general annual PTO bank. PTO accruals are based on service on a pay period: 0-1 year of service – 120 hours; 1-2 years of service – 136 hours; 3 + years of service – 168 hours
- Paid Holidays- Each employee receives two floating holidays Employees receive nine paid holidays, two four-hour time blocks for community service per year, and two floating holidays (granted January 1 and July 1).
- Employee Assistance Program (EAP)- FCH recognizes that a variety of problems can disrupt personal and work life. If an employee needs professional help, they can contact the EAP, which provides confidential access to professional counseling services for help in confronting personal problems such as alcohol/substance abuse, marital and family difficulties, financial or legal troubles, or emotional distress.
- Retirement Plan 401(k)- We contribute 50% of the employee’s 401k deferral , up to a maximum of 3% of the employee’s gross salary. Eligible employees must be at least 21 years old, and be employed with FCH a minimum of 90 days.
- Profit Sharing - FCH may make annual discretionary profit sharing contributions in an amount to be determined at Plan Year end.
- Tuition Reimbursement - Employees may be eligible to receive reimbursement for continuing education for Bachelor’s program after one year of employment with the company.
- Wellness- We encourage and promote healthy behaviors through a Wellness program that offers rewards for those that participate.
- These benefits may be changed with or without notice at any given time.