Medical Claims Analyst

  • location: Miami, FL
  • type: Contract
  • salary: $20 - $25.54 per hour
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job description

Medical Claims Analyst

job summary:
Medical Claims Analyst - Miami, FL

  • This is a contract role expected to last 3 months.
Medical Claims Analyst- - Job Duties:

  • Responsible for providing enterprise-wide reporting and oversight of federal and state regulatory implementation, compliance and exam activities. Primary duties may include, but are not limited to: Communicates state and federal laws and regulations throughout the company and provides enterprise-wide reporting on implementation status and compliance concerns.
  • Participates in enterprise-wide efforts to improve responsiveness to and consistency of company responses to market conduct exams, and provides enterprise-wide reporting on exam status, penalties and trends.
  • Obtains and maintains an awareness of industry regulatory trends, organizational developments, and company strategies that could impact the success of regulatory projects.
  • Assists in the extraction, analysis, and reporting of regulatory data. Establishes and maintains knowledge of database design, data definitions, system capabilities, and data integrity issues.
Job Requirements:

  • Requires a HS Diploma or GED. BA/BS degree preferred.
  • 1-2 years of health care, regulatory or compliance experience that includes data analysis and reporting; or any combination of education and experience, which would provide an equivalent background.
  • Ability to travel may be required.
Compensation: $20.00-$25.54/hr

 
location: Miami, Florida
job type: Contract
salary: $20.00 - 25.54 per hour
work hours: 8 to 5
education: Associate's degree
experience: 1 Years
 
responsibilities:
Responsibilities:

Responsible for providing enterprise-wide reporting and oversight of federal and state regulatory implementation, compliance and exam activities. Primary duties may include, but are not limited to: Communicates state and federal laws and regulations throughout the company and provides enterprise-wide reporting on implementation status and compliance concerns. Participates in enterprise-wide efforts to improve responsiveness to and consistency of company responses to market conduct exams, and provides enterprise-wide reporting on exam status, penalties and trends. Obtains and maintains an awareness of industry regulatory trends, organizational developments, and company strategies that could impact the success of regulatory projects. Assists in the extraction, analysis, and reporting of regulatory data. Establishes and maintains knowledge of database design, data definitions, system capabilities, and data integrity issues. Participates in developing and/or modifying requirements, business design specifications, user training and documentation. Researches and documents business issues, translates business requirements to technical staff/vendor to ensure that requirements are incorporated into system design. Tests and documents solutions and serves as the liaison between users of the tool and technical staff/vendor.

 
qualifications:
Qualifications:

Requires a HS Diploma or GED; 1-2 years of health care, regulatory or compliance experience that includes data analysis and reporting; or any combination of education and experience, which would provide an equivalent background. BA/BS degree preferred. Ability to travel may be required. Prefer experience with Florida SMMC Medicaid contract; experience handling member and provider complaints; excellent English verbal and written communication skills; knowledge of managed care Plan operations.

 
skills: Legal
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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