JOB DESCRIPTION Job Summary Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. KNOWLEDGE/SKILLS/ABILITIES Develop ad-hoc reports using SQL programming, SQL Server Reporting Services (SSRS), Medinsight, RxNavigator, Crystal Reports, Executive Dashboard, and other analytic / programming tools as needed. Generate and distribute standard reports on schedule using SQL, Excel, and other reporting software. Collects and documents report / programming requirements from requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and rework. Identify and complete report enhancements/fixes; modify reports in response to approved change requests; retain old and new report design for audit trail purposes. Analyze data sets and trends for anomalies, outliers, trend changes, and opportunities. Create comprehensive workflows for the production and distribution of assigned reports, document reporting processes and procedures. Assist with completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. Demonstrate Healthcare experience in Quantifying, Measuring and Analyzing Financial and Utilization Metrics of Healthcare.
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Job Type
Full-time
Career Level
Entry Level