THIS IS AN ON-SITE POSITION. MUST BE ABLE TO BEGIN RIGHT AWAY.
Responsibilities
- Responsible for gathering and translating business requirements into data queries (SQL), models, and tools to allow for insightful data analysis
- Create and maintain databases in Microsoft Access; develop, maintain or implement procedures for data entry, data cleaning, documentation and other administrative tasks
- Generate and manage monthly Executive Summary and high-level Microsoft Excel reports generated from internal and external sources
- Interface with QNXT Production Support (QPS) on development and testing of new reports; interact with EAST Team to facilitate new requirements and change requests (i.e. Fee schedule, benefit, code updates)
- Troubleshoot reports and letter generation issues; provide updates to management, resolve or document problems; partner with Information Technology, ETL and QNXT (EAST) teams to resolve issues
- Communicate with internal departments and vendors to identify and resolve issues
- Audit inquiries from Utilization Management (UM) systems (i.e.QNXT, ICIS, Actuate, ICMS) for accuracy of content and compliance (UM requests/determination letters, Appeals/Inquiries)
- Assist Care Management staff with difficult issues and resolve problems; assist Supervisor in development of process improvements tools and staff training
- Perform, research, and summarize findings; download and prepare reports abstracted from external vendors' reporting systems as needed; conduct testing on system enhancements
- Perform additional duties and projects as assigned by management
Qualifications
- Bachelor's degree in Computer Science or equivalent years of work experience required; plus
- Minimum three (3) years experience managing relational databases to include database management and data analysis required
- Experience with care management, health insurance, or health claims preferred
- Experience writing system specifications, expert knowledge of relational database concepts and facility with SQL (i.e. queries, tables, forms, and reports)
- Demonstrated experience in data analysis and reporting required; able to identify anomalies, trends, inconsistencies and make recommendations to improve processes, workflow and operations
- Advanced skill level in Microsoft Access and Excel required; excellent working knowledge of database tables, forms, queries and reports a must
- Knowledge of Medical, Hospital, Eligibility processing systems (i.e. V3, QNXT) and utilization management systems (ICIS, Actuate, ICSM) highly preferred
- Strong critical thinking and analytical skills required; must be an effective problem solver
- Able to work well in a fast-paced environment with competing priorities and strict timelines
- Excellent time management and project management skills; able to prioritize and multi-task
- Detail oriented with the ability to work well independently and as a team player
- Excellent verbal and written communication skills a must
- Must meet performance standards including attendance and punctuality