Healthcare Analyst II

Medica
US - Minnesota - Hopkins
January 13, 2025

Description Medica's Encounter Data Analyst will be responsible for supporting ACA encounter data submissions to the Center for Medicare & Medicaid Services (CMS).
This individual will be working closely with several internal business units on a day-to-day basis.
Coordinate with enrollment & billing and claims operations teams to identify, escalate and resolve data issues appropriately.
Work with Medica IT to ensure completion of EDGE Server upgrades when needed.
Perform routine data reconciliations to ensure data submission integrity.
Monitor & track encounter metrics to ensure timely submissions.
Responsible for maintenance of existing reports and development of new reports as needed.
Informed on CMS risk adjustment updates, and determine impact(s) to existing processes.
Collaborate with Compliance & Health Services on internal and CMS regulated audits (RADV).
Act as a liaison between Health Services and external vendors to ensure smooth audit completion.

Required Qualifications -

Bachelor's degree or equivalent experience in healthcare related field

3+ years of related work experience beyond degree

Basic understanding of Health Insurance and life cycle of a claim

Proficient in at least one data reporting tools (e.g.
SQL, Snowflake, SAS)

Excellent analytical and problem solving abilities

Previous experience working in health care/health insurance sector

Strong communication, documentation, project management skills

Proficient in Microsoft Excel, PowerPoint and Word

Experience with developing detailed documentation of policies and procedures

Strong interpersonal and communication skills with an ability to work collaboratively with both internal and external stakeholders

Preferred skills or experience -

ACA, Risk Adjustment, and Provider knowledge a plus

Direct encounters experience

ACA RADV experience

This position is a Hub role, which requires an employee to occasionally come onsite to the designated office - Minnetonka, MN - for applicable heads-up work.
Frequency is determined by business need as decided by leadership.

The full salary range for this position is $61,500 - $105,400.
Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.
In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting.
Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention.
We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community.
We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values.
We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.
However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.
41 CFR 60-1.35(c)

Read the full job description and apply online on the recuiter's web-site

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