Manager, Recovery Data Analysis

Provide leadership and direction to a team of highly qualified data analysts responsible for the identification, analysis, and quantification for recovery purposes, claims that have been incorrectly billed or adjudicated.  The position will also be responsible for developing appropriate research methodologies and query techniques to facilitate regular identification of claim payment issues and coordinate their resolution with the appropriate functional areas. In addition, the incumbant also serves as the Operations interface with the various health plans (LOB’s) regarding all matters related to recovery identification. Provide leadership and vision for Service OPS as it relates to recovery identification opportunities.  Plan, manage, and organize staff in a manner that optimizes the unit’s ability to effectively and consistently identify claim overpayment issues across all LOBs.  Design and develop data extraction and file manipulation techniques utilizing a variety of databases within KMHP.  Analysis of claims payment trends and billing practices.  Minimum of five years experience in managed care data analysis or utilization tracking.  Minimum five years management experience; strong PC skills including high degree of competency with MS Office tools as well as a variety of data base management systems. Bachelor’s degree required with Master’s preferred in healthcare or business related field.  Performs other job related duties and projects as assigned.  Supports and carries out the Mercy Mission & Values.