BMPS Data Analyst

AllCare Management Services•Grants Pass, OR

15d•$37 - $40•Hybrid

About The Position

This position is responsible for supporting multiple teams including Benefit Management & Pharmacy Services, Oral Health, Social Determinants of Health, and the medical Directors in the design, development, implementation, and coordination of complex data compilation and analysis that promotes and supports the AllCare BMPS department activities.

Requirements

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others.
Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care.
All relevant experience can be listed in your resume to perform essential duties of the position including the following: lived, volunteer, professional, or a combination of experience and education.
Bachelor's degree in Health Informatics, Data Analytics, Computer Science, Information Systems, Public Health, Healthcare Administration, Statistics, Mathematics, Business Analytics, or a related field; or an equivalent combination of education and experience.
Two to four years of related experience and training in healthcare data analysis, business intelligence, reporting, analytics, or a related field.
Experience working with healthcare data, including claims, medical, pharmacy, oral health, utilization, or population health data.
Experience developing reports, dashboards, and data visualizations to support business, clinical, or operational decision-making.
Experience analyzing complex data, identifying trends, and communicating findings to technical and non-technical audiences.
Proficiency with SQL/T-SQL, Microsoft Power BI, and Microsoft Excel for data analysis, reporting, and visualization.
Experience using reporting and data management tools such as SQL Server Management Studio (SSMS), Microsoft Access, Crystal Reports, and Cognos Report Studio.
Knowledge of healthcare data structures, coding systems (CPT, HCPCS, ICD-10, HCC), and healthcare reporting requirements.
Knowledge of healthcare data privacy standards, including HIPAA regulations.
Familiarity with healthcare interoperability standards, including CCD, CCDA, and FHIR.
Familiarity with healthcare programs and reporting requirements, including Medicaid, Medicare, CCO, and DSNP.
Strong ability to analyze, interpret, and synthesize data from multiple sources to identify trends and support decision-making.
Strong computer skills, including proficiency with Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
Ability to identify process improvement opportunities and support implementation efforts.
Ability to organize, prioritize, and manage multiple projects and deadlines.
Strong written and verbal communication skills, including the ability to prepare reports and present complex information clearly.
Demonstrates accountability, reliability, and professionalism while building trust with team members and stakeholders.
Communicates clearly and effectively with technical and non-technical audiences, including clinical teams, leadership, and business partners.
Collaborates effectively within a multidisciplinary and diverse team environment.
Translates complex information into clear, understandable insights and recommendations.
Exercises sound judgment, takes initiative, and works independently while recognizing when collaboration or guidance is needed.
Organizes, prioritizes, and manages multiple projects, deadlines, and competing priorities.
Adapts to changing priorities, processes, and business needs with flexibility and a willingness to learn.
Uses critical thinking, creativity, and resourcefulness to identify solutions and improve processes.
Maintains a high level of professionalism, confidentiality, and attention to detail when handling sensitive healthcare information.
Builds positive working relationships through respect, accountability, and effective communication.
Demonstrates cultural awareness and respect for diverse perspectives, experiences, and backgrounds.
Ability to apply advanced mathematical concepts such as exponents, logarithms, quadratic equations, and permutations.
Ability to apply mathematical operations to such tasks as frequency distribution, determination of test reliability and validity, analysis of variance, correlation techniques, sampling theory, and factor analysis.
Has an advanced understanding and capabilities in using applicable programs and knowledge of networks.
Must be a strong reference for other users for performing different functions with the computer.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and work with several abstract and concrete variables.
The employee must occasionally lift and/or move up to 10 pounds.
The employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is occasionally required to stand; walk and reach with hands and arms.

Nice To Haves

Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care.

Responsibilities

Creates and maintains detailed listings, reporting, and data visualizations to identify cost drivers and negative trends within medical, oral health, and/or pharmacy data.
Articulates understandable explanations of complex clinical data or trends to all staff through verbal, written, and graphical presentations.
Designs localized utilization, case, and disease management dashboards, models, and reports to support departmental staff.
Regularly interfaces the IT Data Science team as a product owner submitting AzureDevOps Work Items (PBI’s) for the development of production Data Science PowerBI Service Dashboards.
Creates, monitors, maintains, coordinates, and submits regulatorily and contractually required contract exhibit reporting to various government entities (e.g. Exhibit I, HRSN, TOC).
Understanding, using, and incorporating clinical data derived from CCD, CCDA, and FHIR architectures.
Extract, Transform, and Load (ETL) data from various sources.
Creating and using queries written with SQL/T-SQL DQL (Select) Commands in SSMS.
Work in PowerBI Desktop using PowerBI Data Marts, Symantec Models, DAX, and Power Query to create strong data visualizations.
Use, understand, and categorize data on various healthcare code sets such as CTP, HCPCS, ICD-9/10, and HCC.
Support the data requirements of various MA Programs.
Create and analyze utilization across various standardized Service Categories such as indicated by the Oregon Health Grouper (OHG) for financial and other analysis.
Integrates data from multiple reports to evaluate AllCare member service utilization stratifying, prioritizing, and triaging high risk members for disease management and case coordination.
Assists with collection and interpretation of risk stratification data for AllCare Medicaid and Medicare members.
Works with department staff and IT to collect and interpret REALD & SOGI data to help identify any care gaps or barriers within our member populations.
Assists the Benefit Management & Pharmacy Services department with assessing utilization trends to identify ways to automate prior authorization processes whenever possible.
Runs weekly, monthly, and quarterly reports to highlight current utilization and cost data for department leadership.
Prepares for and participates in all required DSNP training and education.
Maintains punctual, regular and predictable attendance.
Works collaboratively in a team environment with a spirit of cooperation.
Respectfully takes direction from leadership.
Meets all required training including those listed in Relias Learning Module System (LMS).
Performs other duties as assigned.