Brief job information:
This position will support the Medical Management and Pharmacy and Health Management Departments by collecting and analyzing healthcare related data by performing data management, quality improvement and risk adjustment studies and by conducting statistical analysis and generating reports for the organization’s decision makers.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Support operational needs by performing complex analyses on a wide range of organizational data. Investigate and uncover root causes, identify trends, etc. and propose solutions.
- Achieve results by effectively leveraging expertise in healthcare/managed care data including, but not limited to, membership, provider, claims, authorizations, pharmacy, risk adjustment and financial information.
- Commitment to customer service achieved through timely, accurate, and supportable deliverables.
- Support customer needs for what-if scenario analysis by developing analytical tools/models.
- Ensure understanding of customer needs by proactively clarifying scope and requirements and keeps customers apprised of project status through effective communication.
- Achieve high-quality deliverables by identifying each assumption and the underlying methodology in order to assure accuracy in executing projects.
- Manage multiple department projects by effectively prioritizing work and communicating workload issues to management.
- Develop and maintain up-to-date knowledge of the Data Warehouse and other organizational data sources.
- Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
- Contribute to team effort by accomplishing related results as needed.
- Accepts and performs other duties as assigned.
- Bachelor’s Degree, or equivalent experience required
- 4+ years of proven analysis experience highly preferred, or 2+ years of proven analysis experience in a healthcare/managed care environment.
- Possess the ability to effectively interact with, and present findings to customers at all levels of the organization including operational managers, medical directors and executives required.
- Proficiency with MS SQL (queries) highly preferred.
- Understanding of CPT, DRG/APR-DRG, APCs, MDCs and other clinical codes related to claims/utilization and risk adjustment highly preferred.
- Experience with managed care contract terms/analysis a plus.
- Experience in a Medicare Advantage and ACA environment a plus.
- Experience with MS Bl products a plus.
- Expert skills in MS Office productivity software, especially MS excel.
- Excellent technical, interpersonal, written and oral communication skills required.
- Superior analytical skills required.
- Able to lift up to 30 pounds
- Use proper body mechanics when handling equipment
- Standing, walking and moving 50% of the day.
- Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.