Health Data Analyst I

Upper Peninsula Health Plan•Marquette, MI

1d•$25•Hybrid

About The Position

This position is responsible for analyzing health plan data related to health services delivery, health-care costs, quality of care, insurance coverage and access to care. The Health Data Analyst works with health plan staff to support the efforts of each department’s data analysis needs using data from a variety of sources, including medical and pharmacy claims data, hospital inpatient/outpatient data, revenue and enrollment data.

Requirements

Understanding of SQL and MS SQL Server
Excellent project management and organizational abilities
Excellent human relation and oral/written communication
High level of technical and problem-solving skills
Keyboarding proficiency and advanced knowledge of MS Office (Word, Excel, Access, PowerPoint)
Bachelor’s degree in an appropriate science or related discipline such as health information technology, health information management, computer information systems or related field
One (1) to three (3) years of coursework related to data analysis or computer science

Nice To Haves

Bachelor’s degree in an appropriate science or related discipline as above with a dual major or minor in mathematics
One (1) to three (3) years of experience developing reports or analyzing data in a healthcare environment
Knowledge of accounting software systems/applications
Knowledge of claims and coding and billing methodologies
Knowledge of clinical HEDIS, NCQA and CMS regulations

Responsibilities

Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
Collaborates with internal health plan staff to define data analysis projects, identify appropriate data sources, and develop meaningful and actionable output. Provides coaching and guidance to staff and acts as a resource for clinical, claims and finance staff on data analyses needs.
Produces and analyzes monthly data reports for medical and pharmacy expense, revenue reconciliation, clinical utilization management and claims payment. Identifies and escalates potential issues to department directors.
Organizes, sorts, and filters data in order to distinguish patterns and recognize trends. Develops and maintains data preparation and validation routines to support data mining. Reviews reports to ensure the accuracy and validity of presented information.
Utilizes tools such as SQL and Microsoft Office products (Excel, Access, PowerPoint, Word, and Visio).
Solves moderately complex problems and/or conducts moderately complex analyses. Escalates issues as necessary to the Data Infrastructure Manager
Collaborates with the Compliance Officer to provide detailed data analysis activities for potential fraud, waste and abuse identification.
Attends educational seminars as required; maintains knowledge of current billing, reimbursement and clinical coding schemes; attends department meetings; serves on committees and participates in workgroups as required.
Maintains confidentiality of client data.
Performs other related duties as assigned or requested.