Healthcare Data Analyst II

2 weeks ago

Springfield, United States PacificSource Health Plans Full time

Summary:

Provide essential data support and coordination activities for various business critical analysis and reporting needs to help achieve the goals and initiatives identified in PacificSource Strategic Plan, as well as in alignment to departmental mission and vision. This role will provide analytics support related to healthcare cost and utilization, identification of opportunities and evaluation of health services activities, including, but not limited to, care management, disease management, wellness programs, quality programs and early identification of high-risk populations with directions from level 3 and 4 analysts and analytics leadership. Analytical role may vary and involve diverse array of projects and opportunities to gain knowledge of contract language, healthcare utilization, performance analysis for clinical programs, state and federal guidelines.


Essential Responsibilities:

  • Draft and develop reports and analyses to support internal and external business processes, as well as assist in helping the organization in compliance of state and federal regulatory requirements.
  • Facilitates routine reporting and ad-hoc information requests by running pre-programmed code scripts and macros and by collaborating with senior analysts in creating queries/reports through the appropriate programs.
  • Develop general health insurance business content knowledge as well as specific knowledge related to assigned business areas of analytics support.
  • Prepare assigned ad hoc analyses related to cost and utilization opportunities.
  • Contribute to and initiate development and maintenance of documentation and training materials including job aids.
  • Collaborate with senior analysts to perform statistical analysis and modeling techniques on large data sets, including the use of standard statistical packages such as R or Python as directed.
  • Complete analyses around health care data, utilization, quality initiatives, outcome, and performance analysis for clinical programs with directions.
  • Assists with quality assurance adherence to ensure accuracy, completeness, and reliability of project-related information data resources and reporting initiatives such as participating in data validation projects and providing feedback on development of unit testing, error checks and validation processes.
  • Perform data extraction to meet project requirements as directed. This would include cleaning, transformation and pre-processing data using software programs such as t-SQL, SAS, etc.
  • Support the development of data visualization solutions that allow customer to interact with the data using data visualization software solutions such as Tableau or Microsoft Power BI.
  • Support presentation of complex data, analysis and findings to teams in a way that is clear and understandable.
  • Gather and generate information used to understand health costs and assist with making recommendations to health plan on cost analysis.
  • Assist in the development of capabilities and performance measurements, such as collaborating with level 3 and 4 analysts in supporting NCQA/HEDIS audit compliance and accreditation by compiling and maintaining needed reporting, effective and satisfactory procedural documentations, information/data flows, and business rules.


Supporting Responsibilities:

  • Meet department and company performance and attendance expectations.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.


SUCCESS PROFILE


Work Experience: 3 years’ experience in health insurance or related field. Healthcare analytics experience is preferred.


Education, Certificates, Licenses: Bachelor's degree in Mathematics, Computer Science, Statistics, Engineering, Biostatistics, Epidemiology, Health and Medical Economics, Public Health or similar research related field required.


Knowledge: General knowledge of business principles, theories and concepts. Proven ability to manage multiple projects and competing deadlines. Ability to manage workload within a team environment and with minimal direct supervision. Ability to conceptualize solutions to complex problems; readily anticipates problems and identifies solutions. Ability to deal responsibly with confidential information. Ability to document and adhere to department policies and procedures. General knowledge of in at least one statistical/analytical programming tools such as R, SAS, SPSS. General knowledge of other technical applications such as Tableau, Power BI and web-based database tools. Skilled in Microsoft Office: Word, Excel, PowerPoint and Outlook. Preferred knowledge: Familiarity with Medicare Five-Star, Oregon Quality Incentive Measures and/or NCQA HEDIS. Working knowledge of medical costs is desired, while experience with medical coding and terminology. Entry level understanding of advanced analytics methods (such as machine learning, multivariate statistics, cluster analysis, simulation and neural networks). Master’s degree or above in Mathematics, Computer Science, Statistics, Engineering, Health Economics, Public Health or similar research related field preferred.


Competencies:

  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Contributing to Team Success
  • Planning and Organizing
  • Continuous Improvement
  • Adaptability
  • Building Trust
  • Work Standards


Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.

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