Demonstrates leading analytical expertise in data extraction and reporting, and possesses expert-level technological skills. Delivers guidance and mentoring to team members as well as other analytic staff within HAP. Identifies opportunities for technical enhancements to increase data extraction and reporting capabilities. Provides comprehensive quantitative as well as qualitative statistical analysis to support corporate wide strategic decision making as it relates to medical cost savings initiatives. The position will provide senior level expertise in mining market and internal data; writing analytical reports and projections; and designing reporting formats and analytical tools to support leadership decisions and recommendations that result in medical cost improvements, clinical program modifications and alternative network strategies. Presents to and advises Senior Leadership and/or key stakeholders on issues and recommended solutions to medical and network management cost saving initiatives.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Provides mentoring and guidance to other analysts. Ensures data integrity and reporting accuracy of the department. Helps facilitate healthcare knowledge development, and works to augment analysts' technical skillset.
- Provides advanced statistical and geographical analysis and trending of claims data. Creates graphical and visually esthetic presentation reporting.
- Leads the department in identifying opportunities for technological enhancements that will increase efficiencies and provide additional analytical capabilities. Creates automated reporting processes and develops best practices.
- Conducts analysis associated with medical cost saving initiatives, leading indicators, rate model and pricing related data, contract efficiency with providers, and adherence to quality standards. Participates and/or leads cross-functional corporate business teams and meetings in the development of medical economics programs, targets, and results as they relate to specific corporate strategies and programs.
- Develops best in class and forward thinking methods/criteria for measuring and summarizing healthcare performance data. Integrates information from multiple sources, discerns implications for future analysis and identifies opportunities for enhancing integrity of medical data.
- Prepares baseline and trend analyses or metrics (e.g., PMPM and Utilization per 1000) for targeted medical cost categories, geographies and segments. Conducts analysis of membership mix and its resulting impact on utilization models. Validates findings against best in class benchmarks. Utilizes baseline metrics and trends to establish medical cost savings forecast models.
- Supports the development and implementation of strategic medical management and/or network management initiatives, product offerings or other strategic business programs through extraction, analysis and summarization of appropriate data sets and benchmarks.
- Partners with IT, Finance, Product Management and Market Intelligence, Claims, Client Services and areas within Health & Network Management to champion, develop, and monitor sound cost valuation methodologies for medical and/or network management programs and initiatives.
- Communicates and describes the findings to business questions and objectives pertaining to medical costs, contracting performance, and/or clinical/network performance to key leadership and/or stakeholders.
- Prepares and delivers well-organized and compelling presentations to reflect key findings, analytic methods to determine such findings, future analysis and implications; and the identifications of opportunities to drive business improvements.
- Performs cost benefit analysis for key organizational programs and initiatives impacting medical cost and performance.
- Assures compliance with sound principles of economic assessment and uses explanatory and predictive models in the development, support and analysis, and determining the value of future medical management initiatives.
- Performs other related duties as assigned.
- Bachelor's degree in Health Policy, Health Care Economics, Biostatistics, Epidemiology, Finance or other closely related field.
- Master's degree preferred.
- Minimum of five (5) years of progressive analytical experience in a healthcare or managed care/insurance related setting with specific exposure to case management, disease management, patient/member data, as well as provider contracting and reimbursement data and methodologies.
- Experience with data interpretation, analysis, and reporting; clinical and financial data; predictive modeling and forecasting; key performance indicators as it relates to medical cost data.
- Experience automating complex reporting processes and developing best practices and reporting standards.
- Experience in mining and migrating medical cost performance data to a single platform preferred.
- Minimum of three (3) years of experience in leading staff in projects or supervisory/management position preferred.
- Project management experience in running corporate wide projects.
- Nature of the work requires progressive interpersonal communication, decision making, financial and technical skills; ability to introduce new ideas, processes, measures and tools to improve healthcare performance.
- Must exhibit the ability to function in an autonomous manner in a rapidly changing environment.
- High energy; strong leadership, analytical, project planning and coordination skills to enable efficient, timely task completion of deliverables that meet or exceed customer expectations.
- Ability to function in a creative, "out-of-the-box" thinking in order to develop original solutions to overcome roadblocks and meet or exceed customer requirements and expectations.
- Knowledge of medical claims data and managed care membership data.
- Knowledge of business intelligence applications, data, and tools.
- Advanced technical skills, which includes, but is not limited to: MS Access and Excel, Power BI SQL, SAS and/or other statistical software.
- Knowledge of Medicare and Medicaid Reimbursement methodologies a plus.
PHYSICAL DEMANDS/WORKING CONDITIONS:
Normal office environment with minimal exposure to noise, dust, or extreme temperatures.