Senior Recovery Analyst
Universal Health Care - Saint Petersburg, FL

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The Senior Recovery Analyst performs advanced and in depth data analysis and provider profiling to determine recovery opportunities from fraudulent, abusive or erroneous claim payment activities and provide recommendations to reduce future occurrences. Subject matter expert data analysis, trending, forecasting, performance metrics and reporting.

The Senior Recovery Analyst completes data gathering and the trending and process analysis on overpaid Claims. They act as team leader on large projects requiring coordination with multiple departments within and outside the company. Develops comprehensive and detailed analyses on erroneous or fraudulent billing activities in order to support the revenue collection and reconciliation process. Delivers reports and provides recommendations on recovery strategies. Analyzes, designs and implements data models, databases and relational database definitions. Develops detailed data models. Works with client and IT management to establish and maintain consistent data element definitions across computing environments.

Position Responsibilities:
  • Analyzes contractual obligations and identifies/pursues overpayments on claims
  • Prepares details analyses on billing abnormalities and/or questionable billing practices
  • Develops detailed data models. Designs and implements relational data structures
  • Provides centralized point for data gathering, analysis, and reporting for Recovery and Avoidance
  • Completes process mapping, documentation and builds metrics around processes for assessment of performance within Recovery
  • Applies process and data analysis principles to assess, measure, and predict process performance and improvement opportunity
  • Conducts data and root cause analysis, trending and forecasting for existing programs
  • Applies statistical analysis techniques and programs such as SQC and Minitab in analyzing data to make statically valid assumptions on process performance and behavior
  • Creates control charts and other predictive model reports to track the process performance and determine random or special cause variance
  • Applies knowledge of various computer programs to acquire, store and manipulate data extracts from internal operation, host, and member systems
  • Research product, market data, and trends to impact service offerings and improvements
  • Manages productivity to ensure completion of required assignments within given timelines
  • Participates, as needed, in calibration sessions, meetings and communication sessions and/or creates communication tools
  • Maintain centralized policy and procedures and documentation including process flows for the function.
  • Controls, monitor, and facilitate documentation of new of changes to policies and procedures within and across functional areas
  • Establish and maintain effective cross-functional business partnerships across all levels of the department and organization
  • Conducts regular briefing, presentation and information sharing sessions on program results with upper management
  • Produces effective, reports, charts and graphs and presentations
  • Assists management with special projects as needed

Requirements and Preferences:
  • Ability to create and sustain a track record of seeing the big picture, taking initiative and implementing solutions to meet established goals
  • Knowledge of Managed Healthcare, Medicare/Medicaid markets and CMS regulations
  • Knowledge and skills in database design, administration, and query development
  • SQC and SPC applied skills and knowledge
  • Six Sigma or comparable certification preferred
  • Expert level knowledge and skills in Microsoft products suite including Access, Excel, PowerPoint, Visio, Word, Project
  • Ability to prepare extensive statistical reports and charts including Pareto and control charts
  • Ability to use statistical analysis tools such as Minitab, SQC Pac, or other similar programs
  • Knowledge and skills in process mapping and charting
  • Possesses a collaborative work style and skills with tact and diplomacy
  • Excellent judgment, analytical ability, and problem analysis techniques
  • Excellent consultative, communication and management, and presentation skills to work effectively with clients, other department Managers and staff
  • Experience with multi-tasking and coordinating projects
  • Must be able to effectively communicate in both written and oral formats, at all levels of the organization
  • Strong organizational skills
  • Works well under pressure with the ability to learn quickly and adapt to change
  • Ability to be objective and analytical in reviewing all types of business and systems data
  • Ability to work flexible schedule
  • Ability to work overtime as required
  • Bachelor's degree required, preferably in MIS, or equivalent experience in information systems
  • 5 years’ experience in Managed Healthcare or similar healthcare related organization
  • 3 - 5 years’ experience directly related to project, business or database analysis; 3+ years’ experience with data analysis/database design technologies and tools
  • Six Sigma Green Belt or above Certification preferred

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