Healthcare Claims Data Analyst


Job Overview

Healthcare Claims Data Analyst Wholl Your Be Working With: Our client is the leading risk intelligence company focused on social determinants of health. Their SaaS platform uses proprietary data science to create powerful risk indices derived from hundreds of data sources. These indices are fused with the enterprise data of their customers to create deep insights into the contours of risk, enabling data-driven decision-making. Our clients mission-focused team of clinicians, data scientists, engineers, and consultants are finding root causes of health inequities and working hand-in-hand with clients to interpret findings and design meaningful interventions. Their work directly impacts the lives of real people across our country. What Your Future Looks Like: Our client is seeking an experienced Healthcare Claims Data Analyst to help plan, design, and implement automated processes for accepting healthcare claims data and transforming it into their standard data model. As the Healthcare Claims Data Analyst, youll have significant experience working with standard claims data formats, including 837, 835, UB, and HCFA formats. You must understand how to quickly organize millions of claim lines to summarize discrete encounters, final paid amounts, care setting (ED, Inpatient, etc.) and the diagnoses and procedures captured in the claims data for each encounter. This is a senior-level position requiring advanced skills in SQL and data science techniques to process large data sets. The optimum candidate will have advanced SQL skills for querying against Parquet data using AWS Athena, and will also have skills in R, STATA, or python for applying statistical and/or machine learning techniques to large claims data sets. Youll work alongside the senior-most technical and account management personnel in the company to understand each clients claims data format, methods for processing quarterly or monthly data refreshes, and performing analyses over years of historic data. What Youll Do: Help lead the design of an automated claims data ingestion process that accepts claims data from hundreds of healthcare clients in varying formats and organizes into a consistent data model. Drive the design and evolution of a logical data model derived from claims data that summarizes discrete encounters and each encounters details, including care setting, diagnoses, procedures, and attributed costs. Acquire and organize raw healthcare data in CSV, TXT, JSON and other formats from our clients using AWS S3 buckets in a data lake organizational model. Create automated ETL processes to transform raw claims data in CSV, TXT, JSON and other raw data formats into Apache Parquet representation of a consistent data model supporting data science, data analytics, reporting and data visualization functions. Drive standardization in client data requests to efficiently gather additional member and patient data from clients to support powerful analytics. Maintain an exceptional level of quality, efficiency, and effectiveness in the deliverables of each product sprint. Job Requirements: What Youll Need: Bachelors degree in related field or equivalent experience; advanced degree preferred. Expert-level understanding of healthcare claims file formats and the domain concepts behind each field. Expert-level understanding of how to identify discrete healthcare encounters ED visits, Inpatient stays, PCP visits, and Outpatient procedures along with final paid amounts from raw claims formats. 5 years of direct experience working directly with electronic healthcare data claims formats to load and organize claims data in multiple formats, including 837/835, UB, and HCFA. Proven experience extracting, transforming, and loading raw claims format data into higher level logical data model constructs. 3 years of direct experience in creating and implementing complex SQL and ETL scripts and processes, especially in a secure AWS environment. Programming skills in Python is a plus. All candidates approved for handling protected health information (PHI) must pass a background screening. Why Join Our Client: Youll join a team of passionate people working collaboratively to build an amazing company that will have a real impact on the world. Youll be empowered to innovate and apply your intellectual curiosity to interesting technical and business challenges. Youll work to use groundbreaking technology and approaches to disrupt old ways of looking at health care. Our client is a fast-paced company led by an experienced executive team with tremendous opportunities for growth. They are located in Washington, DC in the vibrant District Wharf waterfront neighborhood. Our client is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

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