Data Analyst Associate

TriZetto

(Phoenix, Arizona)
Travel Required
Job Posting Details
About TriZetto
At TriZetto, we know that a company is nothing without its associates. That’s why we strive to attract and keep the best in the business. To do that, we’ve created a culture that values, rewards, and nurtures the people who make TriZetto run. We offer our associates a number of opportunities to further develop their career, including Associate Professional Development, Leadership Development Program, and TriZetto Academy.
Summary
Data Analyst Associate Analyzing health care claims data information, including claims, membership, provider, and demographic data obtained from the system sources and databases.
Responsibilities
* Assisting with gathering and reviewing the business rules during the implementation process of new clients for claims that require submission of the encounter data for compliance with government programs, such as Medicare and Medicaid. * Maintaining and adhering to standardized processes through the use of reports based on stored procedures and response files in order to route issues for timely resolution to allow for program compliance on behalf of the client. * Analyzing data in both the claim source and EDM databases to find root cause for encounters still outstanding, identifying various trends in data or processing issues, and routing to the appropriate team for resolution. * Providing information for documentation detailing the procedures, outcomes, and observations and making recommendations for updates and changes to the Health Plan and/or members of the BMS Claims team in order for the data to meet regulatory compliance for programs such as Medicare and Medicaid. * Posting and tracking the results of the response files to monitor Service level agreements for the client and compliance measurements, which includes the use of the EDM Mapping Document for the layout of 837 files in order to understand the correlation of data in the source system such as Facets and QNXT, or for custom databases for TPV file layouts, and the mapping to the EDM database. * Collaborating and working closely with the client and other BMS teams to promote effective working relationships and monitoring response time of error resolution.
Ideal Candidate
* Bachelor's degree in Information Technology, Information Systems, Business or a related discipline required. An equivalent combination of education and work experience may be taken into consideration in lieu of a degree. * Minimum of one year of related healthcare experience with specific knowledge including claims adjudication and adjustment, membership, provider maintenance, code sets, and Professional and Institutional claims. Knowledge of Medicare and Medicaid requirements preferred. * Knowledge of SQL (Structured Query Language) and SSRS (SQL Server Reporting Services), Excel (pivot tables, look-ups, advanced formulas, regressions, etc.), and other BI tools such as regression analysis and other graphical techniques such as scatter plots, bar charts, trend lines, etc. is preferred. * Facets, QNXT, encounters, 837, EDM (f.k.a. MDE Medical Data Express) preferred. * Limited travel.

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