Payer Operations Analyst
New
A
AledadeHealthcare data
Remote, United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 4+ years of experience in data operations, analytics, product management, or related technical roles working with complex data within healthcare, product development, SaaS, or similar environments.
- Required Skills
- SQLSnowflakeJiraTableauDatabricks
Requirements
- Bachelor’s degree.
- 4+ years of experience in data operations, analytics, product management, or related technical roles working with complex data in healthcare, product development, SaaS, or similar environments.
- Intermediate SQL programming experience.
- Technical fluency with data warehouses, BI and visualization software, file-transfer systems, and workflow management tools.
- Experience with tools such as Snowflake, Databricks, Tableau, SFTP, and Jira.
- Ability to navigate complex data environments and trace data flows across internal and external systems to identify root causes.
- Ability to collaborate across teams and communicate technical insights and business impact to diverse stakeholders.
- Healthcare domain expertise, including understanding of value-based care, Alternative Payment Models (APMs), Medicare, and non-MSSP quality measures, is preferred.
Responsibilities
- Identify, triage, route, and resolve data quality issues across payer data feeds.
- Partner with payers and internal teams to address broken SFTP connections, delivery delays, and file transmission failures.
- Coordinate clinical quality submission audits by managing documentation, organizing patient data files, and locating clinical evidence with the Quality Reporting team.
- Maintain contract metadata, including contract names, TINs, and administrative details, for downstream data integration.
- Investigate and resolve manual care gap upload failures.
- Collaborate with Payer Solutions, Product, Engineering, Field Operations, and payer partners to investigate and resolve data issues.
- Lead cross-functional data initiatives from discovery through implementation by mapping workflows, aligning stakeholders, and establishing task ownership and deliverables.
- Analyze payer data feeds and metric anomalies as a subject matter expert.
- Maintain SOPs for data issue triage, clinical ingestion troubleshooting, and Primary Source Verification audits.
- Address root causes, advocate for higher-quality payer feeds, and streamline internal ingestion workflows.
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