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Sr Strategic Claims Analyst PHII

2 months ago

Ohio, United States Metro Health Foundation Full time

Sr Strategic Claims Analyst PHII - Care Delivery Admin Brklyn Hts

Sr Strategic Claims Analyst PHII - Care Delivery Admin Brklyn Hts Location:

BROOKLYN HEIGHTS Biweekly Hours:

80.00 Shift:

0800-1630 The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County’s safety-net health system operates four hospitals, four emergency departments and more than 20 health centers. Summary: Operates with considerable autonomy to provide guidance and direction in analytical functions within Population Health Innovation Institute. Supports the evolving need to manage program evaluation and the outcomes for value-based payment agreements. The outcomes can be related to any of the triple aim expectations of these programs and/or agreements, including financial outcomes, patient experience outcomes, and clinical quality outcomes. The work will also involve connecting the outcomes and processes to MetroHealth efforts in population health and the social determinants of health. Qualifications: Required:Bachelor’s Degree in Business, Finance, or Health-focused major.4 years of progressive financial analytical experience in healthcare OR actuarial proficiency.Working knowledge of healthcare data and the inter-related nature of coding nomenclatures (e.g. DRGs, CPTs, etc.)Experience requesting and extracting data from healthcare information systems.Demonstrated ability to manipulate and analyze data derived from disparate sources.Advanced knowledge of healthcare utilization review, revenue cycle, cost allocating, and their impacts on financial and strategic performance.Foundational knowledge of relational database structures.Experience with SAS/SQL or similar programming languages.Strong analytical, critical thinking, forecasting, and communication skills (verbal and written).Highly proficient in MS Excel, PowerPoint, and Word.Ability to take abstract thoughts or ideas, hone them into an analytical plan, and support leadership-ready reports.Ability to interact effectively with a wide range of cultural, ethnic, racial, and socioeconomic backgrounds. Preferred:Experienced in project valuation, statistical significance testing, business case analysis, and development.Prior Epic experienceExperience with data visualization programs like TableauKnowledge of artificial intelligence, machine learning, or deep learning methodsExperience with statistical modeling/testing and regression analysis.Experience with a large healthcare hospital system (public system highly desirable). Physical Demands:May need to move around intermittently during the day, including sitting, standing, stooping, bending, and ambulating.May need to remain still for extended periods, including sitting and standing.Ability to communicate in face-to-face, phone, email, and other communications.Ability to read job-related documents.Ability to use a computer.

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