Okay, I've searched for Claims Analyst roles in Bronx, NY, requiring 3-5 years of healthcare experience, emphasizing SQL and SAS skills, and related to Medicare and Medicaid. I found 87 positions for you. Would you like to see the details?

Sure. Here's the analysis:

Job Analysis:

The Claims and Encounter Analyst role at CenterLight Healthcare PACE is fundamentally about enhancing claims department processes through data analysis and compliance assurance. This position demands not just a keen analytical mind, but an understanding of the complex healthcare landscape, particularly in relation to Medicare and Medicaid regulations. Key responsibilities include analyzing claims data, validating outcomes, conducting root cause investigations for denials, and maintaining submission workflows—all of which require an eye for detail and an ability to identify improvement opportunities. Candidates will face challenges such as ensuring compliance amidst evolving regulations and reconciling discrepancies in claims processing. Success in this role is marked by the candidate's ability to improve efficiency, enhance provider relationships, and support the broader mission of delivering quality care to participants. Strong quantitative skills and familiarity with coding standards like HCC and ICD-10 are essential to navigate the intricacies of medical claims effectively.

Company Analysis:

CenterLight Healthcare PACE occupies a critical space in the healthcare sector, serving older adults in the New York metropolitan area through a non-profit model that emphasizes individualized care. The company's mission to enrich lives aligns well with the role's focus on enhancing claims processes to support patient care. The culture seems to value teamwork and interdisciplinary collaboration, which is evidenced by the emphasis on a team-based approach to care delivery. For an analyst in this role, this means being part of a larger effort that impacts the well-being of a diverse participant base, which may include addressing language and cultural differences. The position likely has visibility across various teams, requiring the analyst to navigate complex team dynamics and work closely with external vendors and providers. The strategic aim of the role connects to the company’s growth and operational efficiency goals, indicating that this hire is pivotal for optimizing claims processing as part of their healthcare services. A successful candidate will not only align their skills with the technical demands of the role but also resonate with the organization’s mission and values to thrive in this environment.

Absolutely. Here are some mock interview questions that could come up:

• Tell me about a time when you had to analyze complex data to uncover a problem. How did you approach it?
• Describe a situation where you identified a process improvement in a claims or healthcare context. What steps did you take?
• Can you give an example of how you ensured compliance with regulations in your previous roles?
• How do you prioritize tasks when faced with multiple deadlines, especially in data-heavy environments?
• How would you validate DRG grouping and pricing outcomes? What specific knowledge or tools would you use?
• What methods would you employ to analyze trends in encounter rejections and denials?
• How would you approach improving the provider scorecards you’re responsible for developing?
• Imagine you are tasked with resolving a significant claims denial issue that has impacted several providers. How would you handle the situation?
• If you discovered a gap in compliance during an audit, what steps would you take to address it?
• Why are you interested in working for CenterLight Healthcare PACE specifically?
• How do you see your background in data analytics contributing to our mission of providing individualized care?
• What do you understand about the challenges facing older adults in managed care settings, and how can your skills help address those challenges?
• Are there specific tools or systems you have experience with that would be beneficial for this role? Can you describe how you have used them?
• What questions do you have about our interdisciplinary approach to care and how the Claims and Encounter Analyst fits into that?