Job Description :
Data Modeler
Dayton, OH
6 month C2H
Video

Job Description
Must have healthcare background
Able to understand and explain the differences/uses of schemas
Logical/physical/conceptual model
Understanding of transactional data systems
Experience (as individual, not as a member of a team) in creating data models based on healthcare information Nature of work:
Support the implementation of new EDS Data Hub strategy.

Skillsets:
Able to understand and explain the differences/uses of schemas
Logical/physical/conceptual model
Understanding of transactional data systems
Experience (as individual, not as a member of a team) in creating data models based on healthcare information

Job Responsibilities:
Collaborate with Configuration to help define system requirements associated with Member Benefits
Develop the strategic direction of member benefits across all states and product lines
Develop and maintain a catalog/database of all member benefits
Ensure compliance with member benefit regulations across all product lines (Essential Health Benefits, State Provider agreements, CMS requirements, Mental Health Parity, etc
Facilitate meetings with business owners and users to achieve benefit design solutions that meet the needs and expectations of the business for all product lines
Lead and communicate annual benefit changes with Product leads
Partner with the Actuarial Science team to identify impacts of member benefits and make informed suggestions for future benefit changes
Manage the development and execution of test plans and scenarios for all benefit or reimbursement designs
Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment related issues
Develop and utilize reports to analyze and stratify data in order to provide answers to member benefit issues identified within the department or by other departments
Lead development and maintenance of fee schedules
             

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