Job Description

POSITION SUMMARY:
To be fully engaged in providing Quality/No Harm, Customer Service and Stewardship by providing the Clinical Analytics team expertise by leveraging technology to help business process owners understand medical trends, clinical program effectiveness and performance in order to maximize Health Plan medical program performance and outcomes.

PRIMARY ACCOUNTABILITIES:
Quality/No Harm:
• Design and Summarize conclusions gained from analyzing data using statistical tools like Microsoft Excel, SQL, SAS and others.
• Understand clinical and financial concepts necessary to manage department information sources.
• Utilize concepts and tools of clinical analytics, such as capture forecasting/trend studies.
• Provide actionable analysis to business process owners to enable leaders of key areas to build, implement and identify solutions to address medical margin business performance gaps.
• Utilize data analysis/financial modeling techniques to measure the potential financial opportunities/impacts of medical margin action plans.
• Create measurements and reporting of participation in population health, medical management and quality programs, and develops strategies to grow and improve results, as appropriate.
• Create measurement and reporting of financial and clinical outcomes impacts realized as a result of the implementation of medical margin action plan and clinical management programs
• Ensure the integrity, accuracy, and timeliness of information sources. Maintain proper documentation of procedures.
• Improve and innovate department operations and information quality

Stewardship:
• Contribute to development and maintenance of reports necessary for management of medical margin performance and clinical outcomes
• Support the ability for customers to consume Clinical Analytics deliverables through clear, concise and succinct written and verbal communication.
• Consistently seek ways to improve operational and financial efficiencies through better use of resources
• Exhibit clear, sound and accurate judgment in making decisions. Display willingness to make decisions in a timely manner, include appropriate people in decision-making process, and be able to explain reasoning for supported decisions.

Customer Experience:
• Support achievement of specific annual department goals and objectives.
• Support in maintaining a medical margin performance and accountability model, in which
• Clinical Analytics provides accurate, transparent medical margin performance monitoring.
• Support the Clinical Analytics team in assisting the business process owner in evaluating the potential medical margin impacts in a consultative and supportive manner, enabling the business process owner to make informed decisions.
• Optimize data accessibility to business owners to improve the timeliness and accuracy of data for decision making
• Develop and deploy reporting, analytical tools and applications for use by those requiring the information, thereby reducing dependence on others to produce needed information.
• Provide training and assistance to these internal customers as necessary

REV 3/20/19

Qualifications:

QUALIFICATIONS REQUIRED:
• Bachelor's degree in Healthcare, Economics, Statistics, Mathematics or related field
• A minimum of 5 years as a data analyst, research analyst or similar type of role;
• Healthcare or health insurance data analysis experience preferred
• 3 years experience using statistical tools for analyzing large datasets.
• 5 years experience extracting and using large datasets and multiple data sources
• 3 years experience SQL programming with data management and data analysis tools
• (SSMS, SQL Developer, etc.)
• Intermediate understanding of Relational Databases and Business Process Alignment
• Knowledge of Economics and Accounting principles and practices, and reporting of financial data
• Knowledge of CPT, ICD-10, and HCPCS coding system
• Knowledge of Medicare/Medicaid/Medigap coverage/guidelines and Commercial
• HMO/Health Insurance contracts preferred
• Experience using statistical software such as SAS, SPSS, SAP, etc. preferred
• Intermediate to Expert level of proficiency with MS Excel creating Charts, graphs, and trending
• Exposure to developing and conducting statistical analyses and modeling
• Demonstrates understanding of data governance
• Ability to work with mathematical concepts, such as probability and statistics
• Possess excellent analytical and problem solving skills
• Demonstrates ability to contribute positively in a team environment.
• Desire to learn to use new technology, applications, and methodologies.
• Strong organizational and time management skills
• Excellent communication skills, both written and verbal
• Experience designing and delivering cross-functional custom reporting solutions
• Experience developing complex visualization dashboards using Power BI, Qlik, Tableau or similar tools.
• Knowledge of Healthcare and/or Health Plan regulatory requirements

PHYSICAL DEMANDS:
• Able to sit and view computer screen for up to three hours at a time to enter data and set up functions.
• Ability to work extended hours as projects demand.
• Ability to occasionally stand, walk, use hands to handle or feel; and reach with hands and arms.

MENTAL DEMANDS:
• Maintain a high level of motivation, initiative, and accountability
• Able to work in often stressful environments, and maintain composure
• Ability to prioritize and organize to maximize quality, value, and service
• Must exhibit analytical and problem solving abilities, to compile, categorize, and verify information
• Ability to work in a team environment
• Professional and positive demeanor
• Desire to learn and master new software