We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary Responsible for supporting provider reimbursement programs, policies, and strategies to ensure unit cost controls meet or exceed corporate objectives for medical cost containment. Analyzes claims, utilization, and medical cost data. Supports the development of strategic, cost effective programs, and makes system or network changes to enhance competitive position. This role requires knowledge of healthcare coding and reimbursements, strong analytical skills, ability to work with large multi-dimensional sets, an ability to identify negative and positive trends, and strong communication skills that enable clear communications to leadership regarding findings. Provider Services leadership will use these findings to make informed decisions regarding financial goals tied to provider reimbursements.
Education & Experience Required: • Bachelor's degree in Business Administration, Finance, Healthcare, Information Management or equivalent experience
• 3 years' experience in healthcare analysis, data management or equivalent
• Strong knowledge of CMS coding and provider reimbursement methodologies
• Proficient in Microsoft Office suite, with an emphasis in Excel and data analysis and reporting
• Working knowledge of structured query language (SQL), and SQL Reporting Services (SRS)
Preferred: • Quality or Process Improvement experience
• Experience with data visualization tools such as Tableau, Power BI, etc.
• Government claims experience
• Work with alternative payment models
Key Responsibilities • Assesses provider payments against TriWest targets for reimbursements to include discounts and alternative payment models (APMs, e.g. pay for performance) Acquires claims data from primary or secondary data sources.
• Identifies, analyzes, and interprets trends or patterns in complex claims data sets and provider data files
• Develops visualizations and presentations to summarize and explain data findings or reimbursement issues.
• Evaluates the completeness and accuracy of claims data.
• Works closely with Provider Services and Finance leadership and SMEs on process and quality improvement strategies and/or provider education efforts, resulting from claims data analyses and findings.
• Define problems, collect claims data, establish facts, analyze claims data, and report the findings to appropriate stakeholders.
• Collect, aggregate and disseminate data in understandable, digestible, and useful ways across the organization.
• Will effectively present claims data information and respond to detailed claims payment or coding questions from varied internal or external groups
Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach.
Information Management: Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Advanced analytical skills; knowledge of fundamentals of accounting and sound business processes; extensive knowledge of Microsoft Excel; proficient with Word; process diagram and documentation experience preferred; research and project management skills.
Working Conditions Working Conditions: • Favorable working conditions in a climate-controlled office space
• May work within an office environment
BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:
- Medical, Dental and Vision Coverage
- Paid time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- Paid volunteer time
TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $78,000 - $92,000 per year.
