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Based on industry and health plan knowledge, this position will support the development of health data strategic plans, policies and procedure for utilization and cost containment information, including provider profiling, and providing useful clinical and analytical conclusions that identify potential issues, cost-savings or opportunities or assist in retaining current market share and attract new business.
This position will lead a dynamic team charged with maintaining a data warehouse including extracting, validating, interpreting, preparing, and analyzing large amounts of data to deliver high-quality, complex, and timely analytics/business intelligence reporting that ensures business leaders have the data necessary to produce actionable outcomes in ongoing daily operations and strategic planning initiatives. This position is responsible for ensuring data quality through validation and governance of analytics solutions for both internal and external customers. This position is responsible for maturing and scaling an enterprise business intelligence and analytics architecture.
Duties and Responsibilities:
- Will participate in the design, development, implementation, modification and evaluation of software tools that incorporates clinical analysis tools to help identify opportunities in payer reporting, provider and employer analysis and profiling, case management and utilization trends.
- Develop team to perform functions necessary to support the enterprise initiatives
- Analyze various data and reports to identify potential issues, cost-savings or opportunities, including but not limited to trends, cost-drivers, service mix changes, provider mix changes, reimbursement anomalies, charge comparisons, changes in payment methodologies or disease trends or other relevant conclusions that can assist overall contracting, quality, medical management, wellness strategies as well as strategic objectives of PreferredOne.
- Consult and support the development of reimbursement and pricing methodologies, and value-based contracting.
- Provide reporting and analysis to outside organizations including but not limited to HEDIS, Minnesota Community Measurement, the State of MN, and employer groups.
- Create and maintaining a strategic roadmap for enterprise analytics.
- Clearly prioritize analytics projects and request backlogs for analytics team members, maintaining alignment of deliverables with business needs and strategic objectives.
- Analyze and identify the cost and quality drivers affecting a member population which can be used to improve the health risk of the covered population or a subset of covered population or individuals.
- Participate in the analysis, design, development, testing and implementation of Impact Intelligence, Symmetry, Cave Grouper, Impact Pro or other grouping software, and any of its updates.
- Oversee the design, and preparation of provider and employer profiling analyses.
- Support customer engagement and satisfaction by maintaining effective communication and transparency of work and deliverables with core stakeholders.
- Provide subject matter expertise to internal and external stakeholders regarding data and associated metrics.
- Work directly with internal stakeholders to understand reporting requirements in order to develop or modify appropriate reporting solutions and provide recommendations for process improvements.
- Performs other related duties as assigned.
- Provide clinical expertise around payer analytics to enhance care management and network management activities through data storytelling and data translation
- Actively manage staffing, employee performance evaluation, career development, salary planning, expense budget and administration for operations
- Demonstrate professional leadership style and encourage professional growth and development of staff.
- Responsible for hiring and retaining staff to achieve departmental goals.
- Demonstrates passion and enthusiasm for organizations vision and motivates, leads, and empowers others to achieve organizational goals.
- Demonstrates a professional leadership style that provides vision, inspiration, respectfulness and is viewed as credible by others.
- Coach and motivate staff regularly in order to achieve departmental objectives.
Identify, address, and resolve employee conflicts and performance management issues in a timely and professional manner.
- Provide training in order to enhance employee knowledge and understanding of the Company for proper succession planning and career advancement opportunities.
- Understands how people work and has a positive non-threatening presence which commands respect from staff and colleagues.
- Is resilient; remains calm and deliberate under conditions of stress.
Required Education, Experience and Skills:
- Bachelors degree in Economics, Mathematics or Statistics
- 7+ years experience in the health insurance or healthcare industry in the areas of actuarial, finance, value-based contracting, pricing, underwriting, provider contracting, or payer contracting, population health, quality, compliance, provider engagement.
- 4-5 years experience in the financial analysis area of healthcare
- 3+ years managing people in the field of data, analytics or business intelligence
- 3+ years experience with Risk Assessment and Profiling Tools, including Ambulatory Care Groups (ACGs) and Episode Treatment Groups (ETGs).
- Ability to create mathematical models for forecasting and analysis purposes using applications such as Microsoft Access, Microsoft Excel, SQL
- Advanced level of analytical skills with ability to apply appropriate techniques and knowledge in a variety of situations.
- Demonstrated advanced understanding of payment/reimbursement methodologies, and knowledge of HCPCS, CPT, ICD-9/10, DRG, revenue coding, of coding principles and claims submission requirements.
- Excellent communication skills, both written and verbal
- Working knowledge of SQL, including stored procedures and views, and relational and tabular databases, Microsoft Technology Stack including SQL Server, SSRS, SSAS, TFS, MDS, Azure, Visual Studio, Power BI, SharePoint Online, and Excel Online Services.
- Creative problem solving skills
- Staff Development
- Leadership of diverse groups and effectively manage customer expectations
- Knowledge of clinical information systems as applied and integrated with clinical practices
- Project management skills.
- Experience in the health care ecosystem, including understanding the relationship between payers and providers, and how analytics enables transformation
- Masters degree in Economics, Mathematics or Statistics.
- Ability to see humor and have fun in the midst of stress
- Ability to create vision and explain to staff
- 5+ years of data management experience with relational databases including data modeling, integrity, quality, querying, warehousing, and ETL processes.
- Clinical degree a plus
- Must be able to work on a computer for extended period of time.
- Must be able to commute to provider facilities
- Compliance with regulatory and accrediting organizations (e.g., MDH, NCQA) and applicable laws and regulations (e.g., HIPAA, Affordable Care Act).
- Adherence to internal quality control guidelines and processes (e.g., SOC1).
PreferredOne is proud to be an Equal Opportunity Employer.
To apply to this position, please visit: https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=5cae4a9e-a45b-4155-878e-068c1025b452&ccId=19000101_000001&jobId=414175&lang=en_US&source=CC4
Time: Full time
Category: Information technology
Updated: 7/16/2021 12:25:10 PM