JOB SUMMARY

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.

EDUCATIONEXPERIENCE

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

Employment practices will not be influenced or affected by an applicant�s or employee�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.