Data Security Analyst jobs in San Diego, CA

Position Justification: Check Cashing, COB Processing, Provider Dispute Redesign, VE Redesign, Denial

Letter Process Redesign, CVPG Remediation, Outbound Mail Streamlining, Policy and Procedures Road

Map, Training Plan Design, Automation Opportunities, Financial Quality Opportunities

Requirements:

Gather business requirements of multiple project initiatives, including new business, change

management, work flow techniques, and remediation opportunities.

Advanced in MS Excel, must be able to create and use VLOOKUP, and Pivot Tables. General

understanding of SQL Query and Tables. Visio and process mapping.

Partner with stakeholders in IT and Claims Operations. Regularly lead group discussion and hold

recurrent progress performance.

Create business requirement documents including road map and milestone projected dates.

Develop and document process flow including interface between programs.

Must have at least 5 to 10 years of medical claim data analysis experience.

Ability to generate regular daily, weekly, monthly updates on project status.

Experience with requirement gathering of State, Federal, and Health Plan regulations.

Big picture mentality, with capability to manage projects at the micro and macro levels.

Familiarity with Health Plan claims compliance and production and inventory measurements.

General understanding of CPT, ICD, CMS 1450 and 1500, EDI files, Maximum out of Pocket and

Member Benefits, Provider Disputes