Healthcare Data Analyst - Jefferson Health Plan

Job Summary

The Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process.  In addition, the team will provide consistent, accurate reporting to help management from other departments do their jobs more effectively.

The healthcare data analyst will be responsible for compiling, verifying, and analyzing data for trend and other analyses related to clinical, provider, and senior management requirements.  This person will also be involved in defining and verifying consistent, reliable datasets for use by all Health Partners Plans' departments.  They will gain exposure to a broad range of financial, clinical and analytical issues.

Essential Functions:

• Create accurate and meaningful reports for departmental and management decision-making using Qlik, MicroStrategy, MS Access, MS Excel, healthcare business intelligence tools and other reporting tools as necessary.
• Provide utilization and outcome analysis, trend and other reports involving authorizations, claims, and membership data. Analyze data in order to uncover underlying utilization patterns and identify clinical and medical delivery drivers of trends. Examples of data analyses include, but are not limited to: identifying and tracking members for disease and case management, incentive and rewards programs, monitoring and evaluation of performance-based contracting, analysis of demographic mix, benefit changes, fee schedule updates, medical trends and marketing evaluation of expansion opportunities.
• Analyze data for quality improvement studies and analysis (quantitative and qualitative) including trending, statistical analysis, and complex drill down of data to evaluate root causes.
• Maintain and automate reports to support productivity and return on investment programs.
• Verify and analyze report data and prepare documentation of processes needed for development and improvement of applications. Help implement improved applications and processes, where appropriate.
• Prepare, verify and maintain dashboards, which contain frequently requested data and reports, that are professional looking, clear and user-friendly.
• Analyze data for anomalies and assist with checking data integrity.
• Serve as a technical resource to management and staff in developing specific questions to be analyzed while determining the appropriate analysis methodology, performing analysis and strategy development.
• Effectively communicate results of analysis to the intended audience: staff, management, senior-level, and/or executive.
• Research issues to determine source of discrepancies.
• Manage, navigate and mine data from current and future systems and develop streamlined, simplified and reliable information to improve business decisions.
• Develop executive level reports summarizing the financial impacts of quality improvement and cost savings initiatives and revenue projections.
• Develop a working knowledge of the DHS/CMS Risk Adjustment process, HEDIS, NCQA Accreditation, and CMS Stars Program.
• Work with other departments to serve as a subject-matter-expert for claims, membership, utilization, and clinical data.
• Prepare reports for owner and provider groups and share the reports directly with provider representatives. Explain the reports and help them develop initiatives to improve member health, improve member satisfaction and reduce medical costs.
• Analyze providers, both PCP’s and specialists, on the basis of efficiency and effectiveness and develop meaningful reports to help them find areas for improvement.
• Support company-wide initiatives to improve processes and streamline and integrate systems to improve data consistency and integrity.
• Peer review work of other HCE associates, as requested.

• Bachelor’s Degree or higher degree in actuarial science, mathematics, statistics or other analytical field of study.

Experience - Required

• 2 years or of clinical/healthcare experience with emphasis on utilization review, case management, managed care, data analysis and/or quality assurance.

Knowledge, Skills and Abilities - Required

• Experience with provider coding practices using CPT, ICD-10 diagnosis codes, and DRG’s a plus.
• Understanding of delivery and reimbursement of medical services in a managed care environment. Familiarity with the role disease management, utilization management and care management play in a managed care organization.
• Strong problem-solving, quantitative and analytical skills.
• Ability to use business intelligence query tools, computer spreadsheet (Excel), and database languages (Access and others at advanced level).
• Working knowledge of SQL.
• Knowledge of Medicare Insurance and policies preferred.
• Proven skills in report writing and report development. Dashboard development skills a plus.
• Proven skills with data presentation including charts, graphs and other exhibits.
• Ability to communicate effectively both orally and in writing. Ability to explain technical terms to non-technical people and to explain business situations to technical teams.
• Ability to handle multiple responsibilities and changing priorities.
• Ability to quickly learn and implement knowledge of new technical processes.
• Must pay attention to details.
• Excellent organizational skills.