Responsible for conducting analyses of insured medical populations with the goal of identifying opportunities to improve financial and outcome performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities to support the Medical Economics and Informatics Department.MAJOR RESPONSIBILITIES
· Extract, manage, and analyze operational, claims and performance data to identify trends, patterns, insights, and outliers within data using industry standard metrics such as PMPM, Utilization per 1000, and Average Cost.
· Analyze claims, membership, and prior authorization data sources to identify early signs of trends or other issues related to medical care costs and quality
· Draw actionable conclusions based on analyses performed on client data and communicate those conclusions effectively to audiences at various levels of the enterprise and client.
· Translates analyses into client ready deliverables using visualization tools available, such as Tableau.
· Supports the product and client units to identify trend outliers, analyze the trend drivers and perform the work necessary to facilitate the discussion on possible solutions to be shared with internal MEI and leadership teams.
· Provides analytical and technical support for development and QA of Client Level Dashboards and other recurrent reporting.
· Work with business owners to track key performance indicators of program goals and interventions
· Responsible for ad-hoc Client and Market requests for mature programs
· Partner closely with BI/IT on processes to optimize new client data (claims/membership) implementation as it relates to reporting and dashboard functions.
· Works with MEl team members to improve efficiency and accuracy of reporting outputs.
· Collaborate with MEl team members on special projects as needed.
QualificationsQUALIFICATIONS & REQUIREMENTS
· Bachelor Degree or higher in Healthcare Informatics, Health Care Statistics, Public Health Economics, Epidemiology, Mathematics, Computer Science/IT, related field or equivalent experience.
· Master’s Degree preferred
· 5+ years' experience in the Healthcare Industry in payer, provider, and/or vendor organizations.
o Experience in Medical Economics/analytics/informatics with focus on production of value-add and insight is required
o Experience using Medical Claims data (medical cost, utilization, cost benefit analysis, etc.) to perform claims/prior authorization based cost/quality of care analytics is required
o Experience with prior authorization data is preferred
· 3+ years' experience with analytics in data warehouse environment
o Experience using SQL for report writing and data management
o Experience in business intelligence applications, advanced data visualization tools and/or statistical analysis software such as SQL, SAS, and Tableau or other applicable analytic/visualization tools.
o Intermediate to advanced skills with Microsoft Office tools (MS Word, Excel, PowerPoint, Visio, Project) necessary to document, track and present information related to company program/products/clients · '
o Knowledge of healthcare financial business cycle, healthcare quality reporting and analysis, benchmarking is required
o Knowledge of health system functions, terminology and standard ICD-10 and CPT coding systems is highly desirable
o Excellent critical and analytical thinking skills are highly desirable
o Ability to compile information and prepare reports that are easily translatable for client delivery and effectively communicate Medical Economics findings and conclusions to internal and external stakeholders.
o Able to effectively work closely in groups and work independently
o Attention to detail, effective time management and multitasking skills including managing responsibilities (with minimal supervision) and exercise initiative
All your information will be kept confidential according to EEO guidelines.