Data Analyst II, Operations
Role summary
Moda, a healthcare organization, seeks a Data Analyst II for its Claims department. This full-time, remote role involves analyzing medical and pharmacy claims, provider data, membership, and enrollment. Responsibilities include auditing contracts, reviewing policies, developing reports for audit teams, supporting clinical editing, and performing ad hoc analysis. The analyst will create complex healthcare utilization reports, evaluate reimbursement methodologies, identify cost-saving opportunities, and build reporting systems for regulatory compliance. Qualifications include a Bachelor's degree, 2+ years in healthcare claims data, 5+ years with data analysis tools like SAS/SQL/Access, and advanced Excel skills. The role requires strong analytical abilities, attention to detail, and the capacity to work independently.
About The Company
Founded in Oregon in 1955, Moda is a reputable healthcare organization committed to delivering high-quality services to its members and community. With a legacy spanning over six decades, Moda has established itself as a trusted provider dedicated to building a better future for healthcare. The company emphasizes outstanding coverage, compassionate support, and comprehensive benefits for its employees. Moda actively engages with local communities to create healthy spaces and places, fostering a culture of inclusivity and diversity. The organization values diverse perspectives and experiences, believing that they strengthen the organization and enhance its ability to serve its members effectively. Moda's commitment to diversity and inclusion is demonstrated through all its business practices, encouraging applications from candidates who share these values. The company’s mission is to make a positive impact on healthcare by connecting with neighbors and working collaboratively to achieve better health outcomes for all.
About The Role
The Operations Data Analyst II plays a vital role within the Claims department, supporting the analysis of medical and pharmacy claims, provider data, membership, and enrollment information. This position involves auditing contract performance, reviewing policies and procedures, and developing reports to assist audit teams. The analyst supports clinical editing operations and provides technical assistance along with ad hoc analysis for various departments. The role offers a mix of routine tasks and evolving responsibilities aligned with organizational needs, providing opportunities for continuous learning and process improvement. Creativity in problem-solving is encouraged, and the analyst is expected to leverage their knowledge, experience, and innovative ideas to enhance operational deliverables. This is a full-time remote work position, requiring a high level of analytical skills, attention to detail, and the ability to work independently in a dynamic environment.
Qualifications
- Bachelor’s degree in Data Analytics, Mathematics, Computer Science, Finance, or related quantitative fields (Master’s degree preferred).
- Minimum of 2 years of experience working with healthcare billing and claims data.
- Proficiency in statistical, analytical, and problem-solving techniques, especially with complex data sets.
- At least 5 years of experience using data analysis tools such as SAS, MS SQL, MS Access, or other business intelligence platforms.
- Advanced skills in MS Excel and other MS Office applications.
- Effective written and verbal communication skills.
- Ability to work efficiently under pressure and adapt to shifting priorities.
- Strong ability to maintain confidentiality and demonstrate professionalism.
Responsibilities
- Create and analyze complex healthcare utilization reports using relational databases, Excel, and Tableau to support multiple departments.
- Evaluate the impact of reimbursement methodologies for medical claims, including CMS-based models such as RBRVS, DRG, ASC, as well as per diem, percentage of charge, and capitation models.
- Audit vendor and provider contracts and reimbursement policies to ensure accurate payments, translating audit findings into financial insights.
- Identify cost-saving opportunities by optimizing reimbursement configurations, automating processes, and enhancing operational efficiency.
- Collaborate with various departments to implement new programs and policies aimed at claims savings and process improvements.
- Develop and maintain complex reporting systems required for government and regulatory compliance.
- Build and maintain pricing tools to support the accurate adjudication of complex claims.
- Manage large-scale audit projects, facilitate work groups, and present findings to stakeholders.
- Assist department staff with technical functions, including manipulation and interpretation of large data sets.
- Conduct ad hoc analysis for departmental leadership to inform strategic decision-making.
- Perform additional duties as assigned to support organizational goals.
Benefits
- Comprehensive medical, dental, vision, pharmacy, life, and disability insurance plans.
- 401(k) retirement plan with company matching contributions.
- Flexible Spending Account (FSA) options.
- Employee Assistance Program (EAP) to support mental health and well-being.
- PTO and company-paid holidays to promote work-life balance.
Equal Opportunity
Moda Health is an equal opportunity employer committed to fostering a diverse and inclusive workplace. We do not discriminate based on race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status, or any other protected characteristic. All employment decisions, including recruiting, hiring, promotion, termination, and compensation, are made without regard to these factors. We encourage candidates from all backgrounds to apply and join us in our mission to improve healthcare for everyone.