[Hiring] Senior Manager - Diagnosis-Related Group (DRG) Data Analyst @EXL

Role Description

The Senior Manager Diagnosis Related Group (DRG) SME will support the business team in evaluating trends on utilization of products/services based on historical data.

• Analyze care management trends, claim utilization, and member attributes to develop cost-effective quality products/services.
• Retrieve, organize, and perform research/analysis on Medical Health Claim data primarily to identify root cause.
• Proactive thinker and self-starter who enjoys working in a fast-paced and challenging environment.
• Strong understanding of both inpatient MS-DRG/APR-DRG payment systems.
• Experience/knowledge in health care claims, with additional experience in Outpatient, HH, SNF, BH, IRF, Professional, DME, HCD claims being a plus.
• Previous claims payment and auditing experience is beneficial and recommended.
• Understanding of Medical claim terminology and insurance terminology.
• Experience with payer policy, claim system limitations, and provider contracting terms is highly recommended.
• Experience with Pre-Pay and Post-Pay code edit/rules development is encouraged.

Qualifications

• Minimum level of education desired: bachelor's degree or equivalent experience.
• 5-7 years of relevant hands-on data analysis experience.
• 5-7 years of relevant medical claim experience with a good understanding of inpatient MS-DRG/APR-DRG payment systems.
• Strong Healthcare Insurance data experience.
• Experience translating business, regulatory, and payment policy requirements into actionable code edits/rules.
• Demonstrates good written and verbal communication skills.
• Experience using business tools to query large datasets (e.g., Microsoft SQL, Databricks).
• Able to present information to various audiences - technical and non-technical.

Requirements

• Ability to work with large data sets from multiple data sources.
• RHIA, RHIT, CCS Certification (good to have).
• Excellent communication skills with a strong background working directly with coworkers and clientele to identify business objectives and establish requirements.
• Experience working in a team environment and coordinating with business/functional teams.

Benefits

• Exciting, fast-paced, and innovative environment with a group of sharp and entrepreneurial professionals.
• Opportunity to work closely with highly experienced, world-class analytics consultants.
• Learn many aspects of businesses that clients engage in, along with effective teamwork and time-management skills.
• Investment in training in all aspects of analytics and leading analytical tools and techniques.
• Guidance/coaching through a mentoring program with senior-level professionals as advisors.
• Unique experiences that set the stage for further growth and development within the company and beyond.
• Salary range for this role: $120k - $125k.