Healthcare Data Analyst - Jefferson Health Plan

Jefferson Health Plans • Philadelphia, PA

3d

About The Position

The Healthcare Economics (HCE) team provides clinical and financial analyses to management to support business decisions, along with consistent, accurate reporting for other departments. The Healthcare Data Analyst compiles, verifies, and analyzes data for trend and other analyses addressing clinical, provider, and senior management needs. The role also helps define and verify consistent, reliable datasets for use across Health Partners Plans and offers exposure to a broad range of financial, clinical, and analytical issues.

The analyst creates and maintains reports, dashboards, and analyses using business intelligence and reporting tools; investigates data patterns, anomalies, and discrepancies; and communicates findings to audiences ranging from staff to executives. The role collaborates across departments and with provider groups to support improved member health and satisfaction, reduced medical costs, and more consistent data and processes.

Requirements

• Bachelor’s degree or higher in actuarial science, mathematics, statistics, or another analytical field of study.
• At least 2 years of clinical or healthcare experience, with emphasis on utilization review, case management, managed care, data analysis, and/or quality assurance.
• Understanding of medical-service delivery and reimbursement in a managed-care environment, including the roles of disease management, utilization management, and care management.
• Strong problem-solving, quantitative, and analytical skills.
• Ability to use business intelligence query tools, spreadsheets such as Excel, and database languages such as Access at an advanced level.
• Working knowledge of SQL.
• Proven report-writing and report-development skills.
• Proven data-presentation skills, including charts, graphs, and other exhibits.
• Ability to communicate effectively orally and in writing, explain technical terms to nontechnical audiences, and explain business situations to technical teams.
• Ability to handle multiple responsibilities and changing priorities.
• Ability to quickly learn and implement new technical processes.
• Attention to detail.
• Excellent organizational skills.

Nice To Haves

• Experience with provider coding practices using CPT, ICD-10 diagnosis codes, and DRGs.
• Knowledge of Medicare insurance and policies.
• Dashboard-development skills.

Responsibilities

• Create accurate and meaningful reports for departmental and management decision-making using Qlik, MicroStrategy, MS Access, MS Excel, healthcare business intelligence tools, and other reporting tools.
• Provide utilization, outcome, trend, and other analyses involving authorization, claims, and membership data; identify utilization patterns and clinical or medical-delivery drivers of trends.
• Analyze data for quality improvement studies, including trending, statistical analysis, and detailed data drill-downs to evaluate root causes.
• Maintain and automate reports supporting productivity and return-on-investment programs.
• Verify and analyze report data; document processes needed to develop and improve applications; and help implement improved applications and processes.
• Prepare, verify, and maintain clear, professional, user-friendly dashboards containing frequently requested data and reports.
• Analyze data for anomalies and assist with checking data integrity.
• Serve as a technical resource to management and staff by helping define analytical questions, select appropriate methods, perform analyses, and develop strategies.
• Communicate analytical results effectively to staff, management, senior-level, and executive audiences.
• Research issues to identify the source of discrepancies.
• Navigate and mine data from current and future systems and develop streamlined, reliable information to improve business decisions.
• Develop executive-level reports summarizing financial impacts of quality improvement and cost-saving initiatives and revenue projections.
• Develop working knowledge of the DHS/CMS Risk Adjustment process, HEDIS, NCQA Accreditation, and the CMS Stars Program.
• Work with other departments as a subject-matter expert on claims, membership, utilization, and clinical data.
• Prepare reports for owner and provider groups, share them with provider representatives, explain the reports, and help develop initiatives to improve member health and satisfaction and reduce medical costs.
• Analyze PCPs and specialists for efficiency and effectiveness and develop reports that help identify areas for improvement.
• Support company-wide initiatives to improve processes and streamline and integrate systems to improve data consistency and integrity.
• Peer-review the work of other HCE associates as requested.

Benefits

• Medical insurance, including prescription coverage
• Supplemental insurance
• Dental insurance
• Vision insurance
• Life and AD&D insurance
• Short- and long-term disability insurance
• Flexible spending accounts
• Retirement plans
• Tuition assistance
• Voluntary benefits, including access to group insurance rates and discounts
• Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service
• Medical insurance, including prescription coverage, is available to all colleagues, including those working less than part-time.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level