Health Data Analyst II

1199SEIU Family of Funds - New York, NY3.9

Full-timeEstimated: $68,000 - $85,000 a year
SkillsBenefits
Responsibilities

Produce analyses and create reports that reflect the activities of medical claims and eligibility data at the 1199SEIU Benefit and Pension Funds
Review and accumulate data of participating physicians, physician groups and subsequent analysis of the quality and efficiency with which medical services are delivered to members
Generate measures of physician performance employing industry standards of quality (i.e. Healthcare Effectiveness Data and Information Set - HEDIS) and efficiency (i.e. Episode Treatment Groups ETG-adjusted episode costs, Diagnostic Cost Group DCG-adjusted patient costs), establish basic units of measurement
Maintain analytical database of physician descriptors and performance measures; enable efficient, flexible responsiveness to internal and external queries and multiple project demands
Create models of physician network development and Accountable Care Organizations (ACO) demonstrating aggregate cost and trade-offs to quality and member access; influence provider network development, benefit plan design, cost savings initiatives and ACO negotiations
Review published literature on physician performance and identify suitable benchmarks for comparison to Fund data; test reasonableness of results and provide support for communications to physicians
Design report cards for transmission to participating physicians and sponsoring organizations; enhance quality and efficiency of health care services to members and promote desirable physician relations
Perform additional duties and projects as assigned by management
Must meet performance standards including attendance and punctuality

Qualifications

Master’s Degree in Public Health, Health Administration, Statistics or equivalent years of experience required
Minimum two (2) years experience with healthcare analysis and management of large health care datasets in a health insurance or public health organization required
Experience with provider data and physician performance highly preferred; strong analytical ability, attention to detail, and understanding of health care organization and policy
Experience with health claims systems, claims data warehouse, provider credentialing, fraud and abuse detection (MCSource, CACTUS, STARTSentinel, QNXT) required; advanced skill level with Microsoft Excel and Access a must
Good knowledge and experience with inferential statistics; Statistical Analysis System (SAS)Enterprise and Basic SQL preferred
Knowledge of 1199SEIU Fund benefit plans preferred; experience with medical billing practices and coding health care industry standards required
Able to work well independently, prioritize multiple assignment and consistently meet deadlines