TPG Capital recently completed the purchase of Change Healthcare’s Clinical Claims Management (CCM) business, which includes the ClaimsXten®, ClaimsXten® Select, ClaimCheck, Secondary Editing, and Episode Manager solutions. The transaction establishes the CCM business as an independent company, with an interim name of ClaimsXten Portfolio. ClaimsXten Portfolio has a long history as a trusted partner and market leader in primary claim editing, delivering value through savings, operational efficiencies, and long-standing partner relationships.
TPG Capital is a leading private equity platform of alternative asset management firm TPG and an active, experienced healthcare and software investor. TPG has a long history of partnering with companies, including the ClaimsXten Portfolio Business–a trusted partner and market leader in primary claim editing, delivering value through savings, operational efficiencies, and long-standing partner relationships. ClaimsXten’s primary solutions are ClaimsXten®, ClaimsXten® Select, ClaimCheck, Secondary Editing, and Episode Manager.
Overview of position
The Sr. Data Analyst -Claims Editing/CXT Cloud Service Operations analyst will work Change Healthcare customers and their leadership teams to facilitate the adoption and utilization of Change Healthcare editing solutions. This position will help develop (or strengthen) existing processes associated with Invoicing and Dashboards. This position is customer facing with clients and will often need to make decisions/answer questions on both a recurring and ad hoc basis. An individual in this role will manage multiple workstreams (blending business and technical resources) to drive requirements, high level design, and work with leadership and finance team to forecast revenue based on contingency models.
What will be my duties and responsibilities in this job?
- Work with clients and internal teams to design and implement analytic solutions and deliverables to manage contingency based editing results including, but not limited to: savings calculations, revenue reconciliation, contingency payment methodology, financial forecasting, business case components, and other ad-hoc analyses required by constituents
- Lead requirements sessions with internal and external stakeholders for Cloud Dashboarding and Invoicing applications. Obtain customer and Change Healthcare Sign off on requirements
- Serve as Single point of contact to client support for all operational aspects of dashboard and invoice (requirements, build, implementation, post- production monitoring, etc.)
- Make recommendations to Cloud leadership and operational teams around trends/anomalies associated with savings or optimization data
- Triage and drive analysis for questions/issues/etc. associated with dashboard and invoicing for both internal and external clients
- Analyze trends associated with client savings and make recommendations to Operations Team for optimization opportunities, new ideas, etc. (new editing logic, enhancements to dashboard/invoice and associated processes)
- Drive new client dashboard/invoice implementations (requirements, resources, etc.)
- Work with leadership and finance team to forecast revenue based on contingency models
- Query and report development to support editing solutions
What are the requirements needed for this position?
- Bachelor’s Degree
- Experience with end-to-end claims editing and processing and related analytics required, i.e., clinical code auditing, pre-submission auditing, post payment auditing, and medical record review3+ years’ experience associated with analytics, finance, process development or operations
- Experience CPT codes, DRG codes, HCPCS, Diagnosis codes, and modifier rules and guidelines
- Ability to write and execute SQL queries
- Expertise in Excel, Word, PowerPoint
What other skills/experience would be helpful to have?
- Bachelor’s Degree in business, analytics, healthcare IT, finance
- Excellent verbal and written skills. Proven ability to communicate effectively with external customers, stakeholders, and cross-functional team members
- Experience with driving requirements sessions (business and technical)
- Analytical and research oriented (financial modeling, trending, etc.)
- Rapid critical thinking skills and problem solving skills Previous experience with a claim editing vendor (understanding of edit lifecycles)
- Large Health Plan Experience (insights into edit vendor processes from a client perspective)
What are the working conditions and physical requirements of this job?
General Office Duties
How much should I expect to travel?
Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.
California / Colorado / New Jersey / New York / Rhode Island / Washington Residents Only:
The applicable base pay for your state is listed below. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, ClaimsXten Portfolio offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with ClaimsXten Portfolio, you’ll find a far-reaching choice of benefits and incentives.
The base pay range for this position is $81,630.00 – $202,200.00
Diversity, Equity & Inclusion:
•At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
•Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity
Feeling Inspired? Ready to #MakeAChange? Apply today!
COVID Vaccination Requirements
We remain committed to doing our part to ensure the health, safety and well-being of our team members and our communities. As such, some individuals may be required to disclose COVID-19 vaccination status prior to or during employment. Certain roles may require COVID-19 vaccination and/or testing as a condition of employment. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.
ClaimsXten General Disclaimer
Change Healthcare is not affiliated with TPG Capital, TPG or the ClaimsXten Portfolio Business. Change Healthcare is providing talent sourcing and other people management administrative tools for the ClaimsXten Portfolio Business for a brief period of time. However, Change Healthcare has no role in the interviewing, selection, employment, or management of ClaimsXten applicants or employees. Though applicants may see the Change Healthcare logo and/or email addresses during the application process (and, if employed, during employment), Change Healthcare serves only an administrative role and is not the employer seeking to fill this role. ClaimsXten Portfolio Business makes all employment decisions concerning applicants.
Equal Opportunity/Affirmative Action Statement
Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.
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