Lead Data Solutions Analyst

Highmark Health • Pittsburgh, PA

5d • Hybrid

About The Position

This role will serve as the Product Owner for a scrum team dedicated against Electronic Health Record (EHR) Clinical Data Exchanges (CDE) and Integration, including integrations, data curation and transformation, downstream use-case and consumption enablement. Uses significant independent judgement and discretion to collaborate with customers on the most complex data and reporting issues in order to understand capability needs, gather project and data specifications, create data sets, operational reports, and analytical deliverables, create business cases and cost sheet analysis, translate high-level business needs into detailed requirements for new capabilities (and change request/enhancements on existing capabilities), analyze data to determine business problems, trends, or opportunities for process improvements, create/execute test plans, provide root cause analysis and corrective action plan, verify delivery of customer needs, and ensure quality delivery. Identifies, documents, and resolves risks, defects and issues. Analyzes market trends for competitive insight to correlate into business value statements. Uses functional and organizational knowledge to mentor Associate, Intermediate, and Senior Data Analysts, as well as others outside of immediate team. Leads project teams or actively participates as a SME on the most complex projects (cross functional, with potential regulatory risk exposure, customer service & financial impacts). Acts as the face to the customer; primary customer contact; may negotiate project requirements versus resources with customer. Resolves the most complex issues (may involve multiple systems) and/or develops alternative solutions with understanding of potential regulatory risk exposure and customer service & financial impacts, ensuring that resolution addresses all potential impacts. Act as a SME on how the most complex new data and reporting enhancement are developed using an expert level of understanding of end-to-end processes and potential integration issues. Requires expert level of understanding of data store and end systems impact of changes across enterprise-wide systems (including regulatory risk exposure, customer service & financial impacts).

Requirements

• 7 years of experience in IS/IT
• Bachelor’s degree in Business Administration, Business Management, Information Technology, Information Systems or related field
• Knowledge of HEDIS (Healthcare Effectiveness Data and Information Set) and NCQA/Stars ratings for CMS/ONC Reimbursement, as well as Risk Adjustment, Utilization Management, and Care Management practices for Healthcare Payers.
• Agile Scrum methodology and Certification as Product Owner (CSPO, or similar)
• Experience collaborating with senior stakeholders for requirements and prioritization, executive communication and presence, conflict resolution, etc.
• Healthcare data exchange standards and formats, including HL7 v2 (ADT, SIU, ORU), HL7 v3 (CDA, CCD), and Fast Interoperable Healthcare Resources (FHIR)
• Experience with Electronic Health Record (EHR) system data exchanges for Payer/Provider mutual benefit, including one or more of Epic/Epic Payer Platform, Athena Health, Veradigm eCC, Oracle Health, Medent

Nice To Haves

• 5 years of experience in Process Improvement
• 3 years of experience in Project Management
• 3 years of experience in Health Insurance Industry
• 3 years of experience in Healthcare Industry
• Master's degree in Business Administration, Business Management, Information Technology, Information Systems or related field
• Six Sigma
• Project Management Professional (PMP)
• Familiarity with key development approaches and architectures including Github/DevOps CI/CD, YAML and Cloud Infrastructure as Code, Data Lakehouse Architecture concepts

Responsibilities

• Lead in working with customers, Data Software Engineers, Data Architects, Capability Managers, and other team members to capture capability needs and drive quality data and reporting business solutions on complex issues.
• Create and maintain deliverables such as data set creation, operational reports, and analytical dashboards.
• Collaborate with or lead cross-functional teams, leveraging diverse data skills and perspectives to proactively identify and address data-related challenges across project phases, driving data-driven insights and solutions to ensure successful project delivery.
• Provide required business and/or subject matter expertise for both project and production related activities on complex issues, including new strategic programs or initiatives impacting current and existing systems.
• Ensure compliance for required standards and all necessary approvals have been obtained throughout the project lifecycle.
• Interface with the business areas, customers, partners, vendors, technical staff and project teams to drive value, return on investments and innovative solutions. This includes providing alternative solutions, including vendor solution acquisitions, with maximum benefits while reducing cost (e.g. cost benefit analysis, pros/cons of solutions).
• Lead in supporting various aspects of requirements testing (e.g. testing plan, scenarios, documentation, defect management) to ensure minimal production defects are realized and completing analysis of the results tying back to customer impacts.
• Communicate in an exemplary manner with team members, customers, partners and management, including assisting with or conducting requirement walkthroughs and sprint reviews, reporting project status, enabling vendor solutions and providing accurate and concise documentation.
• Provide thought leadership and strategic direction in Data, Product and Technology Solutions.
• Other duties as assigned or requested.

Benefits

• Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
• As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
• Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
• Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
• We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
• For accommodation requests, please contact HR Services Online at [email protected]
• California Consumer Privacy Act Employees, Contractors, and Applicants Notice

What This Job Offers

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