Here are sample job advertisements for these types of roles…
Senior Healthcare Data Analyst
The Senior Healthcare Data Analyst position involves programming, data mining and analysis of healthcare data with an emphasis on medical economics, clinical and financial reporting.
An inquisitive and detail oriented mind and a passion for using data and analytics to drive results
is critical to the success of this position.
- Analyze medical cost and utilization trends is support of medical economics and population health initiatives supporting our ACO
- Work with key business owners to establish and meet their analytic needs and the analytic needs of the organization
- Execute the various outcome and predictive analytic studies that support MHN’s model of care.
- Management, maintenance, and design of integration strategies regarding eligibility and empanelment including data quality, reporting and retention initiatives.
- Assist with the design, development, and maintenance of the Analytic DataMart including quality checks, identifying data issues and working with partners to create solutions
- Complete a variety of clinical and financial client ad hoc analyses in an efficient and timely manner.
- Developing and using risk models for comparative analysis and patient stratification
- Work with IT teams to operationalize analytic and reporting innovations
- Conduct analysis to support Shared Savings and other key improvement programs
- Develop actionable dashboards and reports to support care management and ACO operations
- Must be analytical, detail oriented, and a problem solver
- Expertise in data manipulation, analysis, and presentation
- Advanced knowledge of medical claims, pharmacy, and eligibility data
- Ability to work independently on multiple projects. Must have strong organization and time management skills
- Experience with risk adjustment methodologies and predictive analytics
- Experience developing visualizations and working with BI tools
- Experience developing medical performance metrics and clinical quality measures (Physician Scorecards, HEDIS, PQRS, etc.)
- Minimum 4 years of professional experience in a data analytics role within healthcare (payer, provider, consulting)
- 4 – 10 years of experience using Base SAS, SAS/Macros, and SQL
Bachelor’s degree in statistics, public health, information systems, computer science, or a comparable program with a quantitative emphasis. Master’s degree preferred.
- Supports research and analysis of financial data, draws conclusions and provides consultation to internal and external partners for use in administering specific programs and processes related to medical expense and utilization.
- May create comparative views of unit cost information that contracting teams can utilize to identify outlier contracts.
- Conducts ongoing monitoring of medical cost savings initiatives.
- Assist the business units to identify trend outliers, analyze the trend drivers and perform the work necessary to facilitate the discussion on possible solutions.
- Performs detailed analyses, including accumulation of data, financial modeling, and reporting of outcomes.
- May provides detailed analytics to provider network contracting teams in support of the negotiation process.
- Develops ad hoc views of data that illustrates underlying trend issues for both cost and utilization.
- Performs additional duties as assigned.
- BA/BS Required in Mathematics, Economics, Healthcare or other quantitative discipline
- 3-5 years of experience working in a healthcare setting either within a provider health system or health insurance company required
- Strong knowledge of and experience working with healthcare data including but not limited to claims, testing results and pharmacy data required
- Preparing dashboards and preparing and presenting data using a data visualization tool such as Tableau preferred
- Strong data querying skills using tools such as SQL or SAS Enterprise Guide preferred
Duties & Responsibilities:
- Provide analytical support for the Claims, Ancillary, Medical Management and Provider Network departments.
- Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to management.
- Create financial models to evaluate the impact of provider reimbursement changes.
- Gather data and conduct ad-hoc analyses as directed by other Finance Analysis team members and assist with the development and presentation of analytical data reports.
- Support Financial Analysis projects related to medical cost reduction initiatives.
- Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results.
- Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance.
- Must have a Bachelor’s degree from an accredited institution majoring in Math, Finance or Actuarial Science
- Must have analytical work experience within the healthcare industry specifically focusing on healthcare claims (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
- Must have proven work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis.
- Must have experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting.
- Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
- Basic understanding of Medicaid and Medicare programs or other healthcare plans.
- Experience in modeling financial impact of provider reimbursement changes.
- Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
- Strong project management experience and ability to handle multiple projects in a fast paced environment.
- Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
EEO Law Poster and Supplement
Conducts analysis of claims and payment data across CHOICE health plans in support of ensuring payment integrity and cost containment. Identifies anomalous utilization patterns, investigates cost containment, and tests alignment with vendors contracted rates. Reconciles and validates underlying analytic data claims, and utilization management systems. Tests the integrity of utilization and payment data across plans and functions. Engages in activities to support corrective actions to functions, CHOICE Operations and Compliance as directed. Works under general supervision.
- Assists the Manager in analyzing and validating managed care claims and comp grids against provider contracts, member eligibility, benefit grids, and authorization data to ensure VNSNY CHOICE pays our Providers appropriately and VNSNY CHOICE contains cost.
- Investigates utilization and claims coding patterns to identify potential fraud, waste or abuse and coordinates with Compliance and Special Investigation Unit for recoveries as necessary.
- Analyzes affordability of medical cost against premium revenue for membership panels of providers, in specific settings, or across other attribution categories as appropriate.
- Communicates with internal departments (i.e. Claims, Providers, Finance etc) to validate existence of integrity leakage points, and coordinates to develop and implement corrective solutions and recovery.
- Attends meetings with analytics teams, product teams, operations, and allied departments to communicate status of investigative projects and identify new areas of opportunity or priorities. Keeps management informed as necessary.
- Utilizes CHOICE analytic data warehouse and native claims systems and other supporting data for investigation.
- Validates accuracy, timeliness, and performance of claims processing vendor as directed
- Conducts analysis of delegated vendor claims data to test affordability, support contract negotiations, and identify potential errors or Fraud, Waste, and Abuse for further investigation by Special Investigation Unit Compliance, or other departments.
- Assists encounter team in ensuring alignment of claims to encounters.
Education: Bachelors degree required preferably in Technology, Information Science, Mathematics or statistics.
Experience: Minimum of three years managed care claims analysis experience required. Experience in financial or operational analytics preferred. Knowledge of Medicare and NYS Medicaid claims processing rules and coding experience with DRG, ICD10 and CPT4 required. Proficiency in standard business applications such as Microsoft Office required. Proficiency in claims processing platforms such as FACETS required. Proficiency in data analysis software such as SAS, R, or Stata preferred. Proficiency with SQL preferred. Excellent communication and analytical skills required.