Senior Healthcare Analyst

New England Quality Care Alliance (NEQCA) - Braintree, MA3.8

Full-timeEstimated: $78,000 - $100,000 a year
EducationSkills
I. GENERAL SUMMARY:
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The Sr. Healthcare Analyst will perform analysis, synthesis, and modeling of data to support system contracting, performance reporting, physician and hospital benchmarking, financial planning, and forecasting processes for the Wellforce Medicaid ACO. The Healthcare Analyst will build strong working relationships with key internal and external customers, acting as the liaison between end users and the development team to ensure the needs of the business is met through reporting.

II. PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:
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1. Essential Functions:
  • Works under the direction of Government Payer Sr. Specialist to develop and distribute data and reports to internal and external customers, supporting contract performance and strategic initiatives.
  • Perform routine analysis, synthesis, and forecasting of claims, quality, clinical, and/or membership data to support pay-for-performance goals.
  • Provides analytical support for capitation operations.
  • Provides support to NEQCA physicians, Local Care Organizations (LCOs) and Administrators by handling requests for data, reporting, and contract information. This support may require some time on-site assignments at the LCO central office.
  • Supports settlement process of health insurance contracts.
  • Assists business development and contracting effort through physician practice valuation analysis.
  • Performs other similar and related duties as required or directed.
2. Challenges/Problem Solving:
  • Utilizing existing workflow process and building new ones to ensure clear and accurate dissemination of reports and results against targets, and to support the implementation of contractual terms with respect to data and financial information.
  • Balancing financial and strategic goals with provider reimbursement needs.
  • Developing patient analyses such as high value / high cost patient targeting, disease management analysis, and total cost of care analysis.
3. Decision Making Authority:
  • Measurement, calculation, and communication of progress toward earned performance incentives using established procedures and methodologies.
4. Leadership Responsibilities:
  • Displays strong verbal, communication and presentation skills.
  • Provides strong customer focus and relationship management skills.
  • Works effectively in a fast-paced, matrix environment.
  • Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working group's achievement of goals, and to help foster a positive work environment.
  • Provides mentorship and guidance for other analysts on the team
III. JOB REQUIREMENTS
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A. JOB KNOWLEDGE AND SKILLS
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  • Advanced Excel, Access, and other database programs
  • Experience with Spotfire, Tableau, or other BI tool a plus
  • Business analysis / project management principles (requirements gathering, documentation, expectation management)
  • Strong SQL skills
  • Knowledge of claims and/or clinical data
  • Attention to detail required
B. EDUCATION
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  • Requires a Bachelor's degree in a quantitative, finance, technical or health care analytics related discipline
  • Master's or MBA preferred, but not required
C. EXPERIENCE:
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  • 3-5 years analytical experience
  • Healthcare experience required
  • Experience with Medicaid or government programs a plus
  • Experience working with health care data and performing comprehensive drill-down analyses from both a clinical and/or business perspective within the managed care environment.
IV. WORKING CONDITIONS/PHYSICAL DEMANDS:
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  • Work is in a fast paced office-based setting.
  • Reliable transportation is necessary. The NEQCA office is located in Braintree with travel to Local Care Organizations and community hospitals.
  • Work often includes meetings outside of normal business hours
AMERICANS WITH DISABILITIES STATEMENT:
Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. New England Quality Care Alliance reserves the right to modify position duties at any time, to reflect process improvements and business necessity.