The Visiting Nurse Service of New York (VNSNY) is the nation’s largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For 125 years, VNSNY has been committed to meeting the health care needs of New Yorkers with compassionate, high-quality home health care. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life.
Each day, more than 13,000 VNSNY employees — including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals — deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 48,000 patients and members, helping them to live the best lives possible in their homes and communities.
Conducts analysis of claims and payment data across CHOICE health plans in support of ensuring payment integrity and cost containment. Identifies anomalous utilization patterns, investigates cost containment, and tests alignment with vendors contracted rates. Reconciles and validates underlying analytic data claims, and utilization management systems. Tests the integrity of utilization and payment data across plans and functions. Engages in activities to support corrective actions to functions, CHOICE Operations and Compliance as directed. Works under general supervision.
Education: Bachelors degree required preferably in Technology, Information Science, Mathematics or statistics.
Experience: Minimum of three years managed care claims analysis experience required. Experience in financial or operational analytics preferred. Knowledge of Medicare and NYS Medicaid claims processing rules and coding experience with DRG, ICD10 and CPT4 required. Proficiency in standard business applications such as Microsoft Office required. Proficiency in claims processing platforms such as FACETS required. Proficiency in data analysis software such as SAS, R, or Stata preferred. Proficiency with SQL preferred. Excellent communication and analytical skills required.