Systems Analyst with Healthcare

Key Responsibilities

• Data Analysis & Reporting: Analyze utilization trends, claims data, and pharmacy data to identify cost-containment opportunities.
• Workflow Optimization: Document, review, and enhance UM processes (intake, concurrent review, appeals).
• System Enhancement: Define business requirements for IT solutions and conduct user acceptance testing (UAT) for UM software.
• Regulatory Compliance: Ensure all UM processes comply with state/federal regulations and accreditation standards.
• Cross-functional Collaboration: Act as a liaison between clinical staff (nurses, medical directors) and IT/leadership.

Required Skills and Qualifications

• Experience: 3-5+ years in UM, care management, or managed care settings.
• Technical Proficiency: Strong SQL skills, data visualization tools (e.g., Tableau, Power BI), and electronic health records (EHR/EMR).
• Knowledge: Deep understanding of healthcare coding (ICD-10, CPT), claims, and insurance regulations.
• Education: Bachelor s degree in Healthcare Administration, Nursing, or related field.
• Clinical Background: RN or LPN license is highly preferred for clinical data interpretation.

Common Tools Used

• SQL and relational databases.
• Data analysis software (Excel, SAS, SQL).
• Workflow modeling tools (Visio).
• Reporting platforms (Tableau, Power BI).