Healthcare Data Specialist

HEALTHCARE DATA SPECIALIST

Company Overview

Over the next ten years, there will be at least 4.6 million hospitalizations from the misuse of prescription drugs in people 65 or older, resulting in $528 billion in annual avoidable costs. RxAnte is on a mission to improve people's health by helping them get more from medicines. A rapidly growing, tech-enabled healthcare services company with over 30 million lives under management, RxAnte has become a leading provider of value-based pharmacy care management solutions for health plans.

RxAnte launched Mosaic Pharmacy Service in 2019, a wholly owned subsidiary designed to offer pharmacy and chronic care management services for our clients' most medically complex and vulnerable members. Using data, advanced analytics, specialized software and pharmacy automation, Mosaic is transforming the pharmacy experience for medically complex seniors while also helping payers achieve their quality improvement and cost savings objectives.

Job Profile

The Healthcare Data Specialist is primarily responsible for ensuring the accuracy, completeness, and quality of healthcare claims data that RxAnte receives from health plan clients. This position requires a deep understanding of enrollment/eligibility files, and pharmacy and medical claims data, including coding systems, reimbursement processes, and regulatory requirements. As a member of the Analytics team, and working closely with the Data team which is responsible for data ETL, this position requires a strong foundation in data analysis, SAS programming skills, and enthusiasm for identifying patterns and trends, and troubleshooting discrepancies within healthcare claims data. This is a remote work position.

Specific responsibilities include:

• Data Requirements Documentation: Collaborate with the Data team to create comprehensive data requirements documents that outline data sources, data elements, data formats, data quality expectations, and any other specific data requirements.

• Acceptance Criteria Development: Define clear and measurable acceptance criteria. This includes establishing data validation rules, data accuracy thresholds, data completeness standards, and other criteria for assessing data quality and fitness for use.

• Data Validation and Reconciliation: Create and implement thorough validation processes to verify the accuracy and completeness of data. This involves conducting regular audits to identify and rectify inaccuracies, inconsistencies, and missing data as well as investigating data anomalies discovered by others. This also may include identification and sourcing of additional data sources or literature research to validate population-level metrics. Reconcile raw client data files to internal data warehouses.

• Collaboration: Work with data providers (clients) and other members of the analytic team to resolve issues promptly.

• Analytic Data Management: Responsible for all major data initiatives / management within an analytics-focused team.

• Documentation and Reporting: Document data validation processes, findings, and remediation actions taken to maintain an auditable trail of data accuracy efforts. Devise and generate reports and documentation to communicate data quality metrics and improvements achieved.

• Continuous Improvement: Proactively identify opportunities to enhance data accuracy processes, tools, and methodologies to optimize data quality and reliability. This includes staying updated with industry best practices and emerging technologies in data quality management.

• Other activities as needed.

• Bachelor's Degree in a related field
• Two+ years of relevant/related experience in similar role
• Demonstrated experience working with administrative healthcare data (Medicare data a strong plus)
• Strong technical and analytical skills
• Understanding of government health programs
• Extensive SAS coding experience (R-programming a plus)