Alignment Healthcare is redefining the business of health care by shifting the focus from payments to people. We’ve created a new model for health care delivery that cuts costs and improves lives by unraveling the inefficiencies of the current system to drive patients, providers and payers toward a common goal of wellness. Harnessing best practices from Medicare Advantage, our innovative data-management technology allows us to commit to caring for seniors and those who need it most: the chronically ill and frail. Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options through Alignment Health Plan, and also partners with select health plans to help deliver better benefits at lower costs.

As a Data Analyst - Claims with expertise in medical claims, you will be responsible for analyzing, interpreting, and presenting data related to medical claims to support decision-making and operational efficiency. You will work closely with cross-functional teams to identify trends, generate reports, and develop strategies to enhance claims management and processing.

Key Responsibilities

Data Analysis & Reporting:

• Analyze large datasets related to medical claims, including billing codes, patient demographics, and claim status.
• Develop and maintain reports and dashboards that provide insights into claims trends, processing times, and reimbursement rates.
• Identify and address discrepancies in data, ensuring accuracy and completeness.

Claims Management

• Evaluate and interpret medical claims data to identify patterns, anomalies, and areas for improvement.
• Collaborate with claims processors and medical coders to resolve issues and optimize claims processes.
• Monitor and assess the impact of changes in regulations, policies, and procedures on claims processing.

Data Visualization

• Create visualizations to communicate findings effectively to stakeholders, including charts, graphs, and dashboards.
• Present data-driven recommendations to management and other departments.

Cross-Functional Collaboration

• Work with IT and software development teams to ensure the integration of claims data into analytical tools and systems.
• Assist in the development and implementation of data-related policies and procedures.

Compliance & Quality Assurance

• Ensure that data handling and analysis comply with relevant regulations and standards, including HIPAA and other data protection laws.
• Conduct regular quality checks to maintain data integrity and accuracy.

Qualifications

• Education: Bachelor’s degree in Data Science, Statistics, Computer Science, Health Informatics, or a related field. Advanced degree or relevant certifications (e.g., Certified Health Data Analyst (CHDA)) preferred.

Experience

• Proven experience as a Data Analyst, preferably with a focus on medical claims or healthcare data.
• Strong understanding of medical billing codes (e.g., ICD, CPT, HCPCS) and claims processing workflows.
• Experience with data analysis tools and software (e.g., SQL, Excel, Tableau, Power BI).

Skills

• Proficient in data analysis, statistical methods, and data visualization techniques.
• Excellent problem-solving skills and attention to detail.
• Strong communication skills, with the ability to present complex data in a clear and actionable manner.
• Ability to work independently and as part of a team in a fast-paced environment.

Preferred Attributes

• Knowledge of healthcare regulations and compliance standards.
• Familiarity with Electronic Health Record (EHR) systems and their data structures.
• Experience with data integration and ETL processes.