This is a Remote opportunity!!!
The Healthcare Intelligence Analyst is responsible for supporting program development and evaluating population health initiatives in a rapidly growing and leading Value based Care health practice. Provides analytical support and program design assistance to key stakeholders and developers which assists in the execution of programs such as transitional care, preferred provider network and disease management.
ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
1) Collects, analyzes and interprets health care data including claims, capitation, member, and provider information.
2) Conducts baseline and trend analyses for targeted value based care programs, patient populations and geographies. Analyzes and researches utilization and unit medical costs.
3) Evaluates potential program implementation by determining return on investment (ROI).
4) Monitors and validates program effectiveness including cost savings and established key performance indicators and benchmarks.
5) Calculates baseline and trend metrics such as cost per member per month (PMPM) and Utilization per 1000 and applies analytical concepts and tools. Seeks to enhance understanding of membership, utilization, cost and revenue trends across networks and patient populations.
6) Creates data visualizations and compiles data.
7) Collaborates with Business Analytics, Finance, Care Management and Clinical Teams to support corporate-wide strategic decision-making.
8) Partners with Financial Planning & Analysis (FP&A) and clinical leadership to set utilization targets, develop medical cost trends and quantify incremental medical management initiatives for forecasting, budgeting and long range planning purposes.
9) Provides ad hoc reporting and analysis.
EDUCATION: Minimum Bachelor’s degree required with a major in a quantitative discipline (actuarial science, statistics, operations research, mathematics, or economics) or with a healthcare focus (health administration, epidemiology, public health, or biology). Master’s degree preferred.
EXPERIENCE: Minimum 3 years of experience in claims-based healthcare analytics within a managed care environment. Experience with medical claims and membership data from Commercial and Medicaid lines of business.
KNOWLEDGE, SKILLS AND ABILITIES
* Knowledge of OLAP cubes and writing MDX queries a plus.
* Proficient with Microsoft Excel and PowerPoint.
* Proficient with BI visualization tools (PowerBI, Tableau, Sisense).
* Experience writing queries in SQL.
* Ability to compile and effectively report data.
* Working knowledge of healthcare claims specifically differences between institutional vs professional billing and various sites of care/service.
* Familiarity with healthcare reimbursement methodologies and calculations such as DRGs, Revenue Codes, CPT Codes, RVUs, and bundled payments.
* Familiarity with value-based care and utilization management.
* Understanding of data systems and critical thinking skills.
* Strong analytical, research, and problem solving skills.
* Strong verbal and written communication skills.
* Manages multiple tasks within time constraints.
* Work independently and in a team environment.
* Projects a positive attitude and high degree of self-confidence.
* Effectively manages time.
TYPICAL WORKING CONDITIONS
* Full time remote/telework
* Indoor Work
* Operating Computer
* Reach Outward
* Manual Dexterity
OTHER PHYSICAL REQUIREMENTS
* Sense of Sound
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.