Job Description

• Analyze CPT-level data to identify trends, patterns, and insights relevant to healthcare services and payer rates.
• Build and maintain analytical models for cost, quality, and utilization metrics using Python, R, or SQL-based BI tools.
• Develop reports that communicate findings to stakeholders across the organization.

• Ingest and preprocess data from multiple third-party sources and transform it into unified structures for analytics and reporting.
• Ensure compliance with transparency requirements and enable downstream analytics.
• Design automated workflows to update and validate data, working closely with external vendors and technical teams.
• Apply and maintain best practices for data-quality checks (e.g., encounter completeness, claim-level validations) and troubleshooting.

• Develop, maintain, and optimize end-to-end data pipelines — ingestion, transformation, and loading of internal and external sources.
• Collaborate with Operations to design scalable, secure, and high-performing data workflows.
• Implement best practices in data governance, version control, data security, and documentation.

• Ensure data quality through validation checks, audits, and anomaly-detection frameworks.
• Maintain compliance with HIPAA, HITECH, and other relevant healthcare regulations and data-privacy requirements.
• Participate in internal and external audits of data processes.

• Stay current with industry trends, analytics tools, and regulatory changes affecting payer analytics.
• Identify opportunities to enhance data processes and adopt new tools and technologies.
• Share knowledge and best practices with the team across analytics, reporting, and pipeline development.

• Bachelor’s degree in Health Informatics, Data Science, Computer Science, Statistics, or a related field.
• 3–4 years of experience in healthcare analytics, payer operations, or a related field.
• Proficiency building data pipelines using SQL, Python, R, or ETL platforms (e.g., Talend, Airflow, Data Factory).
• Experience with relational databases (SQL Server, PostgreSQL) and at least one cloud environment (AWS, Azure, or GCP).
• Familiarity with BI tools (Tableau, Power BI, Looker) for dashboard creation and data storytelling.
• Strong understanding of claims data structures (UB-04, CMS-1500), coding systems (ICD, CPT, HCPCS), and payer processes.
• Knowledge of healthcare regulations (HIPAA, HITECH, transparency rules) and their impact on data sharing and management.
• Ability to synthesize large datasets, pinpoint issues, and recommend data-driven solutions.
• Excellent communication and presentation skills, with strong project-management, organizational, and cross-functional collaboration abilities.

• Hands-on experience (or strong familiarity) with healthcare transparency datasets — MRF, All Claims — and provider/facility-level data from third-party sources like Definitive Healthcare.
• Comfort with statistical analysis and predictive modeling using Python or R.

• Advanced degree (MBA, MPH, MS in Analytics, or similar).
• Experience with healthcare cost-transparency regulations and handling MRF data specifically for compliance.
• Familiarity with DataOps or DevOps practices to automate and streamline data pipelines.
• Certification in BI or data engineering (e.g., Microsoft Certified: Azure Data Engineer).
• Exposure to data governance or data-quality initiatives.