Overview

The Medicare Compliance Data Analyst acts as the chief auditor for the company and is responsible for reviewing, analyzing, and identifying trends in Section 111, conditional payment, and Medicare Set Aside data to promote and provide insights for internal and external stakeholders. The Medicare Compliance Data Analyst is responsible for communicating MSP compliance strengths, weaknesses, opportunities, and threats to all stakeholders; identifying opportunities for policy and procedure adjustments for external stakeholders; and participating in change management meetings with internal and external stakeholders. The Medicare Compliance Data Analyst acts as a liaison between the national accounts, field sales, and operations (SECTION 111, MSA, conditional payment) teams to support company and customer initiatives. The Medicare Compliance Data Analyst will apply a strong understanding of the inner workings of workers comp and property / casualty insurance to identify new service and product opportunities, work hand-in-hand with customers to recommend and develop customized workflows, and support ongoing strategic initiatives.

Responsibilities

• Reviewing and analyzing SECTION 111 data and the interplay between CP and MSA and SECTION 111.
• Running reports in the company data warehouse and transactional systems.
• Recognizing possible anomalies in the output, and resolving them with the business owners.
• Communicating findings with customers and internal stakeholders.
• Perform audits and other consultative Medicare compliance work.
• Customer training support.
• Stewardship and key data meeting assistance.
• Support in overflow CP work and high-level CP assistance.
• Perform other duties as required/assigned by manager.

Qualifications

Education and/or Experience  

High School Diploma required. Bachelor’s degree preferred. A minimum of one to three years data reporting and data analysis. Prior experience in the insurance industry or related field preferred.

Certificates, Licenses, Registrations  

MSCC required (may be obtained within 1 year of employment)

QUALIFICATIONS

• Must have complete knowledge of general computer, fax, copier, scanner, and telephone.
• Must have advanced computer skills in the use of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, PowerPoint, Vizio and the Internet.
• Must have advanced skills in Microsoft Excel and be able to interpret and manipulate data, including: Pivot Tables; Graphs; Vlookup; and other complex formulas.
• Must have familiarity with data warehouse principles.
• Experience with Microsoft Power BI preferred.
• Must be able to meet deadlines and deliver high-quality, error-free work in a fast-paced environment with limited supervision.
• Must be able to multi-task and have the ability to quickly change focus.
• Ability to follow instructions and respond to managements’ directions accurately and efficiently.
• Must demonstrate accuracy and thoroughness. Look for ways to improve and promote quality and monitor own work to ensure quality is met.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to work independently with minimal supervision, prioritize work activities and use time efficiently.
• Must be able to maintain confidentiality.
• Must be able to demonstrate and promote a positive team -oriented environment and create good working relationships with constituents.
• Must be able to stay focused and concentrate in close quarters with normal distractions and without distracting others.
• Must be able to work well under pressure and meet occasional tight deadlines.
• Ability to manage and direct change, delays, or unexpected events appropriately.
• Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.

WHO WE ARE

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.