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This individual will be responsible for analyzing complex clinical and financial (claims-based) scenarios to support informed decision making. This person works relatively independently with limited direction and supervision. Responsible for gathering and interpreting claims, clinical and administrative data to build effective financial models, make reasonable assumptions, and reach appropriate conclusions. Serves as a resource and consultant across the system and sites to design and produce relevant information to inform strategies essential to the success of population health initiatives.
Job Responsibility:
Prepares analyses and develops routine and special management reports and reporting tools to support ongoing PHO, CIN, RBO operations, finance, care management, clinical risk adjustment, and department management decision making
Analyze the total cost of care and payer contract performance using any and all data systems available
Analyze clinical, financial, and quality performance by site, physician, and contract
Conduct and present analyses that drive improved delivery of value-based care
Works with IT partners to diagnose, correct, and validate any issues with the data populating business intelligence tools
Creates efficient presentations of quantitative and qualitative information
Summarizes analytical findings in ways that business leaders and front-line clinicians can quickly understand and use to drive performance improvement
Assumes responsibility for maintaining current knowledge of government regulations, policies, and trends that affect the health care industry
Requirements:
Bachelor's Degree in Accounting or related field, or Bachelor's Degree in Business, or Bachelor's Degree in Health Care Administration, or Bachelor's Degree in Computer Science
Typically requires 5 years of experience in clinical data analysis or analytics experience in health insurance or healthcare fields
Must have strong analytical skills, advanced Microsoft Office Suite skills specifically in Excel and PowerPoint, and be able to communicate effectively with management and staff at all levels
Advanced analytical skills, including the ability to analyze quantitative and qualitative data and reach sound conclusions
Advanced computer skills, including Microsoft Office Suite
especially Excel
Experience with one or more business intelligence tools (e.g. PowerBI, Business Objects, Strata)
Good communication skills, including verbal communication and business writing
Working knowledge in the healthcare insurance industry, healthcare finances, care management, clinical risk adjustment, and/or physician practices
Good project management and time management skills
Good interpersonal skills, including the ability to communicate at all levels within the organization
Experience and ability to create complex queries in SQL or other query languages
Nice to have:
Experience with EMRs (Electronic Medical Records) preferred
Ability to code in Python preferred
What we offer:
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs