Partner with Payer Strategy leaders in order to provide data driven input that will optimize payer recovery. Proactively data mine accounts and enable action before trends impact client performance. Create and maintain data pipelines, reporting tools and machine learning (models) that will help Payer Escalations focus resources and attention and make objective decisions and focus energies. Identify improvement opportunities in order to assist with business performance advancement.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Explore, manipulate, analyze and use data (Data Science techniques) to identify changes in payer behavior and/or underpayments and denials. Partner with PII Director to build new Machine Learning Supervised and Unsupervised models.
Apply moderately complex quantitative methods to proactively data mine / interpret data and present the key trends and recommendations to leaders within Payer Strategy
Design and develop visual dashboards to be utilized across clients to track and manage issues by Payer. Perform ad hoc reporting as needed.
Audit data using appropriate sampling techniques, data analysis tools and models to ensure accuracy and promote credibility
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Advanced ability to gather and analyze complex data, utilizing deductive reasoning and/or advance data science techniques
Independent, logical thinker with proven ability to perform detailed data analysis and make sound decisions
Intermediate understanding of ICD-10, HCPCS/CPT coding, medical terminology, hospital billing form requirements (UB-04), and electronic remittance advice (ERA/835) responses
Intermediate knowledge of Contract Adjudication applications
Intermediate knowledge of managed care and other healthcare contract language
Demonstrated ability to detect patterns in large volumes of data
Strong communication skills (verbal and written)
Strong contract interpretation skills
Strong relationship building and collaboration skills
Capability to multi-task, be organized, and meet critical deadlines
Proficiency with Microsoft Office applications including advanced Excel skills
Intermediate/advanced knowledge with Relational Database Management Systems such as MS SQL Server and IBM Db2 Database.
Include minimum education, technical training, and/or experience preferred to perform the job.
4-year college degree with major in Business Admin, Computer Science, or Mathematics preferred
Healthcare and/or revenue cycle experience in a provider, servicer or a large physician-practice experience a plus
2-4 yearsâ�� experience in analysis of payer trends and proven track record of using data to provide actionable business results
Fluency in analytics. Qualitative and quantitative analytical skills with the aptitude to interpret analyze complex data and ability to communicate the findings
Fluent in data fundamentals: SQL, data manipulation and modeling, statistics, and data science concepts
1-2 yearsâ�� experience building new Machine Learning models using Python and experience using Pythonâ��s scientific computing libraries
Alteryx and Watson Studio experience a plus
Proficient in Microsoft Excel
Job: Conifer Health Solutions
Primary Location: Frisco, Texas
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.