Medical Billing and Finance Analyst

Overview

Under the direction of the Program Director or designee, the Health Care Data Analyst is responsible for developing and maintaining financial, claim-related and program performance reporting database(s), reports and processes, applying their knowledge of state and federal requirements and detailed program guidelines and reimbursement methodologies. The Health Care Data Analyst works with and analyzes large and complex datasets and synthesizes information to meet a variety of management reporting needs and client ad-hoc report requests. Operational duties include completion of tasks required to ensure quality and accuracy of health care claiming and cost reporting data and preparation of financial and other claim-related reporting in a deadline-driven and fast-paced environment. Communication skills are required to be successful in this role as frequent communication occurs related to explaining program reimbursement methodology requirements to clients and other stakeholders.

Responsibilities

• Develop and maintain data-driven financial, claim-related, and program performance reports for internal management and external client audiences.• Perform compliance reviews of program data, including claims, payments, payment or costs settlement report data for quality assurance and program integrity purposes.• Analyze large, complex data sets to quantify and resolve problems, inform management decisions, monitor program changes and their impact, and communicate important information for internal management and external clients.• Apply knowledge of program systems to identify and troubleshoot issues, participate in testing of software changes and assist clients and external users to effectively use the program’s systems and applications.• Assist in the design and maintenance of internal controls to ensure quality and accuracy of business unit’s work products.• Compile and review claims, payments and/or other financial data for approval or distribution • Identify and resolve any discrepancies, questions or outstanding issues related to claims, payments or other financial data for approval or distribution including coordination with internal staff, health plans, clients, or systems staff.• Prepare financial/claims data for final submission and ensure the quality of the data is accurate and meets regulatory compliance, financial and/or other contractual requirements. • Apply knowledge of state and federal program requirements, program guidelines and reimbursement methodologies in all aspects of work.• Design and produce ad-hoc reports to meet internal management and client requests for data to inform decision-making and to fulfill public records requests.• Complete and synthesize analysis of claims, payments and/other financial data to report to appropriate internal and external stakeholders.• Utilize verbal and written communication skills to effectively communicate program information and explain requirements and methodology to various clients and external users of Umass Chan systems and applications.• Complete tasks required for the preparation and conclusion of the program’s operational, financial or other contractual deadlines including set-up and maintenance of required claiming variables, notifications to clients and other stakeholders of deadlines, claim status, and actions needed.• Preserve confidential, protected health and personally identifiable information and files.• Perform related duties as needed and as assigned.

Qualifications

REQUIRED EDUCATIONBachelor's Level Degree or equivalent in Finance, Economics, Business Administration, Accounting, Health Care Financing, or a related fieldREQUIRED WORK EXPERIENCE• 3-5 years of federal claiming, medical billing other related financial experience.• Demonstrated ability to create complex spreadsheets and reports, using Microsoft Excel, Microsoft Access and/or other systems as necessary and available.• Strong analytic and auditing skills.• Proven competence in independent problem solving and quality control measures.• Demonstrated ability to handle details, multi-task, and prioritize work.• Strong organizational skills and proven ability to prioritize and coordinate multiple tasks and meet deadlines in dynamic environment.• Excellent interpersonal skills.