Senior Encounter Analytics and Compliance Analyst

Title: Senior Encounter Analytics and Compliance Analyst

State Role Title: Info Technology Specialist III

Hiring Range: $108,879 - $117,935

Pay Band: 6

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public - G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Senior Encounter Analytics and Compliance Analyst in the Integrated Care Division.

Job responsibilities will include, but are not limited to:

The Senior Encounter Analytics and Compliance Analyst position is critical in ensuring the quality, integrity, and strategic use of healthcare encounter data across various functions, including utilization analysis, performance evaluation, regulatory compliance, and inter-agency reporting, with extensive experience in writing complex programming code, particularly using Statistical Analysis System (SAS) and Structured Query Language (SQL). This position is responsible for identifying complex trends, anomalies, and insights. They will use programming skills to analyze large datasets, identify data quality issues, monitor trends, and ensure compliance with state and federal requirements. The role involves frequent comparison of current encounter submissions against historical data to identify discrepancies, anomalies, and performance trends. They translate analytical findings into meaningful reports and visualizations that support a range of stakeholders, including executive leadership, policymakers, and partner agencies.

Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org

The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.

DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.

At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:

Extensive in-depth understanding of SAS/SQL programming, including the ability to write, debug, and optimize SAS/SQL code for data manipulation, analysis, and reporting.

Extensive knowledge of data management principles, including data extraction, transformation, and loading (ETL), data quality, and data validation techniques.

Extensive problem-solving skills to troubleshoot and resolve programming issues, data inconsistencies, and system errors.

Considerable knowledge of healthcare claims and encounter technology systems.

Extensive understanding of relational database systems (e.g., SQL) and the ability to interface with databases to retrieve and manipulate data.

Considerable ability to create complex data sets, reports, and visualizations.

Considerable analytical abilities to interpret data, identify trends, and provide actionable insights. Proficiency in performing data analysis and generating statistical reports.

Considerably strong critical thinking skills to evaluate complex data scenarios, develop innovative solutions, and make data-driven decisions.

Considerable knowledge ensuring compliance with necessary federal and state rules, regulations, standards, and laws.

Considerable experience in meeting deadlines.

Considerable experience working with internal/external stakeholders.

Additional Considerations

Competitive candidates should meet these additional considerations:

Considerable understanding of healthcare data systems, including healthcare encounters and claims data.

Familiarity with common healthcare data formats such as EDI standards, X-12, HIPAA, 837 I & P, and NCPDP.

Considerable expertise in healthcare encounter data, including patient visits, claims, and administrative data.

Knowledge of data elements specific to encounters, such as diagnoses, procedures, and service dates.

Special Instructions

You w