Healthcare Data Analyst (4212)
Irving, TX
HMS Holdings Corp. is a national leader in cost containment and program integrity services for government healthcare programs. In 2006, HMS recovered more than $1.0 billion from third parties and other funding sources for its clients, and provided data that assisted them in saving billions more. HMS serves the Medicaid programs of 40 states, 65 Medicaid managed care plans, SCHIP, child support agencies, and the Veterans Health Administration. Together, the Company's service offerings benefit our clients by enhancing revenue and reducing costs.
HMS is seeking a professional to identify potential overpayment scenarios in the payment of medical and pharmacy claims. Individual will also design and conduct the data analyses required to support the identified overpayments.
Required Skills
Detailed knowledge of health care claiming rules for both medical and pharmacy and familiarity with both the requirements for and data on health care claiming forms
An understanding of third-party adjudication process
Ability to independently research and interpret claiming regulations and rules at both Federal and local level
Experience with manipulating and analyzing large datasets. Technical skills will include, but are not limited to: SQL, SAS, Excel, Access
Intermediate level of proficiency in Microsoft Office software application including Word, Excel, and Powerpoint
Experience in applying Correct Coding Initiative (CCI) or Outpatient Code Editor (OCE) or Medically Unlikely (MUE) edit a plus
Detail oriented with excellent communication skills (oral presentations and written) and interpersonal skills
Ability to manage multiple projects simultaneously
Experience Required
Bachelors degree required
At least two years prior experience in health care claiming field, either with a provider of medical or pharmacy services or at a payor for health care claims, including a state Medicaid Management Information System (MMIS) or as a consultant to either providers or payors.
HMS proudly supports our Military Veterans
Equal Employment/Equal Opportunity HMS is committed to providing equal employment and individual advancement opportunity to all job applicants and employees without regard to race, creed, color, national origin, sex, age, medical condition, disability, veteran or marital status, sexual orientation, citizenship status, or any other unlawful criteria.
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