Permanent position
Brea, CA
Summary:
The Healthcare Analyst provides clinical and financial analysis and reporting for existing clients and provides support for pricing new business.
Essential Duties and Responsibilities:
- Acts with honor and integrity, serving as a role model for the company.
- Analyzes prospective and current client utilization data to identify utilization trends, calculate cost of healthcare and identify opportunities to add value to customers.
- Works with internal business customers to define report and dashboard requirements for use in managing day to day operations more efficiently.
- Assists with the QC/Validation of the data currently being developed into the data warehouse.
- Validates the completeness of potential client data files using various techniques.
- Extracts and compiles both internal and external data elements used in all aspects of the business from client pricing, medical cost management, operational reporting and general financial analysis as required.
- Populates existing pricing model with potential client information and makes suggestions on potential improvements to the model or corresponding presentation/reporting.
- Participates in or conducts presentations to prospective clients regarding pricing methodologies.
- Reconciles capitation payments to eligibility data to ensure monthly payments received are accurate.
- Calculates and analyzes monthly capitation payments made to network providers; identifies and investigates unusual fluctuations and determines root cause of potential problems.
- Conducts recurring and ad hoc provider utilization analyses; prepares meaningful, professional reports for health plans.
- Respects and maintains HIPAA confidentiality guidelines.
- Acts as an interdepartmental liaison between offices, departments, and committees.
- Performs other duties as assigned.
Project Management and Execution:
- Coordinate with other departments across the AO such as IM governance & EDW and support conceptualization and development of reporting/analytical methodologies, solutions and initiatives
- Aid in the development of project plans and strategies as well as execute assigned project plans to deliver solutions in a timely manner
- Support collaboration on roadmaps, dependencies, and execution plans across analytical units and with applicable teams in the organization
- Manage the intake requests across the business units; track and monitor the work to ensure critical milestones are met, identify and report/escalate risks to management appropriately; manage stakeholder relations
- Obtain data, direct/execute reporting/analysis, perform interpretations and conclusions, and prepare recommendations.
- Assist in determining business needs by effectively conducting fact-finding interviews and leveraging various tools and analytical methods and then summarize findings in a coherent manner to develop and propose appropriate solution
- Conduct research studies that include collecting data from various sources, analyzing, trending and presenting the findings and recommendations to management
- Support translation of business requirements and unstructured business issues into data analytic problems
- Perform overall program evaluations (i.e., planning-implementation-completion/analysis-reporting) and other assessments such as change management assessments, workflow optimization assessments, etc.
QUALIFICATION REQUIREMENTS:
EDUCATION and/or EXPERIENCE:
At least a Bachelor's degree with emphasis in Economics, Computer Science, Statistics, Math or Business, or equivalent work experience.
- Minimum of 4-6 years’ work experience in an analytical role
- Master degree in a quantitative field preferred.
- Work experience with line item healthcare claims and PBM information is preferred. OTHER SKILLS and ABILITIES:
- An understanding of CPT, ICD-9, Revenue and DRG codes is preferred.
- Must have expensive experience and proficiency leveraging SQL, including loading data, writing update and select statements, and joining tables.
- Experience with Excel spreadsheets and other office productivity applications to share and present analytic results.
- Experience with SAS.
- Experience with statistical analysis tools such as SAS Office Analytics desired.
- Experience with business Intelligence tools such as SAS Visual Analytics desired.
- Ability to understand and work with a variety of data formats to create charts, graphs, tables, and other visual means of representing key aspects of the data.
- Strong written and verbal communications, including the ability to summarize the results of data analysis for technical and non-technical audiences. Must also be comfortable presenting this information via in person meetings as well as webinar technologies.
- Experience with technical writing preferred.
- Must have strong analytical skills with the ability to develop advanced analytic models (e.g. forecasting).
- Must be skilled at prioritizing assignments and working to ensure all mission critical timeframes and deadlines are met.
- Must be able to work independently and demonstrate initiative and problem solving skills working within a fast paced start up environment
