Business Intelligence Operations Lead

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

The Business Intelligence Operations Lead will serve as a leader and collaborator across teams to ideate, plan and execute opportunities to reduce waste, and enhance quality care. This position will complete operational steps for end-to-end implementation, measure efficacy and make timely adjustments for continuous improvement.

Job Description

• Measure effectiveness of system prepayment edits and proactively identify areas for intervention.
• Facilitate decision-making for system changes through conducting cost/opportunity analyses
• Optimization study considering tangible and intangible costs such as savings, member retention, provider disruption, contracting etc.
• Implement and monitor all Business Intelligence configuration requests
• Translate concepts into configurable instructions and communicate to Core team
• Ensure configuration is working appropriately post-implementation
• Measure and monitor outcomes
• Project manage the implementation of new required processes based on BI interventions
• Data Intakes
  • Set up automated file transfers to data warehouse from external sources
• Operational Process
  • Work with internal MetroPlusHealth teams to identify process gaps and develop solutions to drive desired outcomes
  • Develop necessary crosswalks and definitions
  • Complete all required notifications
  • Ensure compliance with all applicable regulations
• Monitoring and QC
  • Develop timely monitoring reports and tools to track outcomes and identify required interventions
  • Research and respond to escalations related to BI interventions
• Ensures all BI payment policies are up to date
• Conducts root cause analysis on all escalations related to BI interventions and implements improvements as needed
• Proactively acts on opportunities to enhance operational effectiveness to reduce waste
• Supports development of metrics, processes, and source materials for New Core System
• Supports new system and data enhancements for Medical Management
• Maintains effective relationships across the company to facilitate development and implementation of cross-departmental strategies

Minimum Qualifications

• A Bachelor's Degree in a healthcare, finance, accounting, business, science or related field is required. Advanced degree in Healthcare administration, Informatics, or quantitative disciplines, preferred
• 5+ years of data analysis or operations in a managed care environment required
• 2+ years of project management experience required
• Experience in health insurance products, healthcare operations, healthcare data analytics and reporting
• SQL query and data visualization technical proficiency
• Excellent process development/management skills to ensure tools, supportive technologies and operational flows are optimally utilized.
• Clinical background, informatics, analytics, and decision-making skills

Professional Competencies

• Integrity and Trust
• Customer Focus
• Excellent Microsoft Office Suite skills
• Written/Oral Communication
• Ability to lead and manage significant change
• Excellent interpersonal, communications, problem solving and negotiating skills
• Ability to work cross-functionally and collaborate across the MetroPlusHealth leadership team

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