Senior Manager - Diagnosis-Related Group (DRG) Data Analyst at EXL

Job description

The Senior Manager Diagnosis Related Group (DRG) SME will support the business team in evaluating trends on utilization of products / services based on historical data - such as care management trends, claim utilization, member attributes, to develop cost effective quality product / services. The ideal candidate retrieves, organizes and performs research/analysis on Medical Health Claim data primarily to identify root cause and is a proactive thinker, self-starter, who enjoys working in a fast-paced and challenging environment with the ability to work independently. Candidate should have a strong understanding of both inpatient MS-DRG/APR-DRG payment systems and have experience/knowledge in health care claims. Additional experience with Outpatient, HH, SNF, BH, IRF, Professional, DME, HCD claims is a plus. Previous claims payment and auditing experience would also be beneficial and recommended. Understanding of Medical claim terminology and insurance terminology. Experience with payer policy, claim system limitations, provider contracting terms are highly recommended. Experience with Pre-Pay and Post-Pay code edit/rules development is recommended/encouraged as well. Salary Range for this role is: $120k - $125k For more information on benefits and what we offer please visit us at exlservice.com • Pull and integrate data from disparate sources (e.g. claims, membership/enrollment, etc.) • Perform quality assurance reviews on data and document the findings • Interpret, analyze and present key findings to internal team & business partners • Conduct deal reviews and work with appropriate stakeholders • Publish the attribution status to all required stakeholders • Research on issues related to attribution and co-ordinate with required stakeholders to bring it to closure • Provide user guide and maintain documentation on existing attribution methodology • Help develop the tools for quality and transparency for attribution • Become the analytical, technical and business co-lead • Coding responsibilities will include SQL and Python primarily Must have: • Minimum level of education desired for candidates in this position is a bachelor's degree or equivalent experience • 5-7 years of relevant hands-on data analysis experience • 5-7 years of relevant medical claim experience with good understanding of inpatient MS-DRG/APR-DRG payment systems. • Strong Healthcare Insurance data experience • Experience translating business, regulatory, and payment policy requirements into actionable code edits/rules • Demonstrates good written and verbal communication skills • Experience using business tools to query large datasets, e.g., Microsoft SQL, Databricks • Able to present information to various audiences - technical and non-technical Good to have: • Ability to work with large data sets from multiple data sources. • RHIA, RHIT, CCS Certification • Excellent communication skills with strong background working directly with coworkers and clientele to identify business objectives and establish requirements • Worked in a team environment and also coordinated with business/functional team What we offer: • EXL offers an exciting, fast paced and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class analytics consultants. • You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth • EXL Health Analytics requires different skill sets at different levels within the organization. At EXL Analytics, we invest heavily in training you in all aspects of analytics as well as in leading analytical tools and techniques. • We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors. • Sky is the limit for our team members. The unique experiences gathered at EXL sets the stage for further growth and development in our company and beyond. The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. EXL Health is seeking a Senior Manager Diagnosis-Related Group (DRG) SME/Data Analyst for our Medical Health Claims.

Requirements

Must-haves

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
Pull and integrate data from disparate sources (e.g. claims, membership/enrollment, etc.)
Perform quality assurance reviews on data and document the findings
Interpret, analyze and present key findings to internal team & business partners
Conduct deal reviews and work with appropriate stakeholders
Publish the attribution status to all required stakeholders
Research on issues related to attribution and co-ordinate with required stakeholders to bring it to closure
Provide user guide and maintain documentation on existing attribution methodology
Help develop the tools for quality and transparency for attribution
Become the analytical, technical and business co-lead
Coding responsibilities will include SQL and Python primarily
Minimum level of education desired for candidates in this position is a bachelor's degree or equivalent experience
5-7 years of relevant hands-on data analysis experience
5-7 years of relevant medical claim experience with good understanding of inpatient MS-DRG/APR-DRG payment systems.
Strong Healthcare Insurance data experience
Experience translating business, regulatory, and payment policy requirements into actionable code edits/rules
Demonstrates good written and verbal communication skills
Experience using business tools to query large datasets, e.g., Microsoft SQL, Databricks
Able to present information to various audiences - technical and non-technical
Ability to work with large data sets from multiple data sources.
RHIA, RHIT, CCS Certification
Excellent communication skills with strong background working directly with coworkers and clientele to identify business objectives and establish requirements
Worked in a team environment and also coordinated with business/functional team

Nice-to-haves

None flagged.

Application prep

Use the role’s language and application details while tailoring your materials.

Keywords to mirror

sqlpython

Platform: oracle-cloud
Effort: medium