Supports organizational & department goals. Identifies problems & areas of opportunity in organizational processes & technology. Maintains & supports a culture of compliance, ethics & integrity. Maintains knowledge of policies & procedures & performs in accordance with the Principles of Responsibilities & applicable regulatory requirements, external laws & accreditation standards. Appropriately reports observed fraud or abuse.
• Develop & suggest tools for outcome & process measurement.
• Builds queries using SQL to extract data from mainframe & server-based data repositories.
• Responsible for developing, maintaining, & troubleshooting various database apps.
• Provides recommendations to leadership based on document analysis.
• Proactively communicates & collaborates w/external & internal customers to analyze information needs & data reqts.
• Collaborate w/developers & subject matter experts to establish the technical vision & analyze tradeoffs.
• Performs Root cause analysis of issues.
• Recommends modifications to established practices & procedures or system functionality as needed to support HPSA Claims Administration.
• Grows expertise in end-to-end claims adjudication.
• Performs other duties as assigned.
• In addition to defined technical requirements, accountable for consistently demonstrating service behaviors & principles defined by the KP Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives.
• Also accountable for consistently demonstrating the knowledge, skills, abilities, & behaviors necessary to provide superior & culturally sensitive service to each other, to our members, & to purchasers, contracted providers & vendors.
• Minimum of 4 years of health care analysis or relevant work experience, in areas such as system analysis or maintenance, data analysis, or finance
• Experience performing sophisticated data retrieval and report development, including extrapolating and interpolating data using multiple resources
• Demonstrated experience interacting professionally with diverse groups; executives, managers, and subject matter experts
• Demonstrated experience providing recommendations and influencing business decisions
• Experience building queries using SQL in one or more tools (e.g. Business Objects, SAS, Crystal, SQL Assistant)
• Bachelor's degree in mathematics, computer science, information technology, health care management, computer engineering, business or related area
• Excellent verbal and written communication skills
• Knowledge of healthcare and/or health plan operations required
• Must have critical thinking skills and the ability to identify, analyze and provide recommendations for process improvement and redesign
Kaiser Permanente - 16 months ago
America’s leading not-for-profit health plan, Kaiser Permanente serves more than 9 million people from 37 hospitals and 611...