Technical Analyst - Population Health and Care Management

Must have SME knowledge. Without SME cannot submit the profile.

Job Summary:

• Must demonstrate strong domain expertise, particularly in the Payor-Provider ecosystem, with a solid understanding of Medicare, Medicaid, and other relevant healthcare programs
• Works with stakeholders to discover, clarify, and document current and future data needs
• Performs mapping of Population Health and Care Management data to a normalized data model.
• Serves as a subject matter expert on the Population health data domains such as Care Management, Utilization Management, Quality Scores, HEDIS, Care gaps
• Builds data concepts to support Population Health use cases
• Serves as a key resource for an assigned customer area to understand and explain business and technical issues and to provide viable technology solutions.

Responsibilities:

• Act as a quality consultant and subject matter expert, performing testing and validation of the mapping of data elements to standards
• Collaborates with technical resources to perform root cause analysis and complete remediation of data quality issues
• Works with customers to clarify and plan for their current and future technology needs. Determines and maps existing business processes/functions and recommends changes required to fit a tightly integrated system.
• Designs and implements projects requiring systems integration, small teams and multiple technical platforms.
• Conducts Return on Investment (ROI) and other financial analysis to support project funding/prioritization.
• Collaborates on driving improvement activities to achieve department and organizational goals.
• Coordinates with functional team to assure consistency and optimization of overall work product
• Assumes a proactive role in driving improvement activities to achieve department and organizational goals to deliver value.
• Maintains current knowledge of industry and business process trends and is able to apply that knowledge to existing business processes.
• Provides subject-matter expertise of Health Ministry processes, policies and requirements in support of functional area process design, testing and implementation
• Identifies opportunities for process improvement and makes recommendations that lead to improvements
• Monitors task assignments to ensure they are performed on schedule, within intended scope and to a defined level of quality.
• Escalates process and project issues that cannot be resolved

Experience:

• Prior experience working as a Population Health analyst in the Healthcare system.
• Must have a working knowledge of relational databases/database structures, SQL expertise desired
• Must have a strong understanding of data collected and used in Claims, Adjudications, Health Insurance and Care and Utilization Management
• Knowledge and experience with ambulatory and acute clinical, billing and claims workflows and clinical information systems.
• Bachelor or Masters degree in related health or finance field ex informatics or bioinformatics.
• Complexity of work: Within the scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment.
• 5 years of experience preferred