Medical Informatics Analyst - Business Analyst Advanced

Provides technical, data and analytical support to customer departments such as Quality, Value Partnerships, Hospital Contracting, Care Management, Risk Adjustment and HCV.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. 

1. Leads or participates, with some direction, in projects where data solutions are necessary.

2. Provides programming and data expertise for simple and moderately complex projects and ad-hoc requests.  

3. Presents data and solutions to internal and/or external customers in a logical way.

4. Provides data support and analysis for programs supporting over 4 million BCBSM beneficiaries using administrative claims and supplemental data. .  

5. Provides analysis and data support for various corporate departments including Quality, Risk Adjustment, Value Partnership, Care Management, and Hospital Contracting, in support of major corporate initiatives such as EMR Connectivity, PGIP, Risk Adjustment, STARS and NCQA/HEDIS.

6. Standardizes, harmonizes, cleans and shares data with others in the organization as well as external customers.

7. Creates and maintains data-centric product solutions, including third party program integrations such as, HEDIS, risk scores andPGIP incentives l.

8. Supports various reporting activities and continuously strives to make them more efficient and easier for the customers to consume.

9. Completes ad-hoc data and analytic requests assigned.

10. Works with IT and Clinical Data Strategy to maintain and enhance our EMR Clinical Data in the Informatics environment.

"Qualifications"

• Bachelors Degree in Computer Science, Information Systems, Business, Mathematics, Healthcare Information Technology or similar degree required.Master's Degree preferred.
• Minimum 4 years of experience.
• Ability to use advanced functions in SQL or SAS or SPSS programming.
• Solid working knowledge of Microsoft tools and software (i.e., Excel, Visio, Access, PowerPoint).
• Competency in programming concepts such as Visual Basic, Business Objects, .Net, MDX, C++, or COBOL.
• Must possess the ability to help others think critically and share complex technical solutions to non-technical audiences both orally and in writing.
• Must be able to translate thoughts and ideas from non-data customers into data-centric solutions.
• Knowledge of data warehousing and data mining concepts including but not limited to ETL, datamart design, fact tables, dimension tables, data views within data marts/data warehouses, olap, rolap, and data models such as star schemas and snowflake schemas.
• Ability to recognize data patterns, quantify potential issues and identify solutions. Ability to standardize, harmonize, clean, prepare and use data for developing datasets, reporting and analysis.
• Basic understanding of epidemiologic principals and population health management concepts desirable.
• Knowledge of healthcare terminology, plan/benefit design, fundamental operational principles and administrative claims data including standard coding schemes such as ICD-9/10 and HCPCS.
   

• Departmental Preferences

• Experience working with EMR/EHR clinical data, including encounters, diagnoses, procedures, medications, labs, vitals, immunizations, and clinical documents.

• Strong analytical skills with experience using Databricks, SQL and data analysis tools to investigate, validate, and reconcile large clinical datasets.

• Experience with EMR platforms CCDA data such as Epic, Oracle Health/Cerner, athenahealth, eClinicalWorks

• Knowledge of C-CDA documents, including clinical data extraction, mapping, transformation, validation, and downstream processing.

• Experience developing and maintaining data mappings and performing data quality, reconciliation, and root cause analysis for clinical data integrations.

• Ability to independently execute EMR operational activities, including project planning, status tracking, issue resolution, stakeholder communication, and process improvement initiatives.

• Experience collaborating with business and clinical stakeholders to identify opportunities for new HEDIS measures, quality programs, and clinical data acquisition efforts.

• Familiarity with cloud-based data platforms and healthcare interoperability standards (e.g., HL7, CCDA, FHIR), with the ability to analyze EMR/ADT data and develop meaningful reporting and insights.