Position: Healthcare Data Analytics consultant
Location: Remote TX preferred)
Duration: 6 Months
Summary
The Senior Healthcare Informatics Analyst independently provides analytics in understanding and improving how health care is valued, utilized and provided. This position will develop analytic attributes that
pertain to patient level health utilization/outcome, provider performance measures, risk-adjusted revenue optimization, medical cost management, and behavior attributes on patient/provider engagement. In collaboration with other business areas and IT, this position leads in problem solving, solution development and strategic planning and decision making. Accountable for complying with all laws and regulations associated with duties and responsibilities.
NATURE AND SCOPE
- This role does not manage people
Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with the following: Clinical Solutions, Clinical Partnerships, Actuary, Provider Reimbursement, and Actuarial, Payment Innovation, IT, Marketing, external vendors, Blue Cross Blue Shield Association and other plan BCBS plan partners.
QUALIFICATIONS
Education
Bachelor's in healthcare administration, statistics, economics, analytics, computer science required
- Master's in related field preferred
- Four years of related experience can be used in lieu of a Bachelor s degree.
Work Experience
4 years of health care, analytics, IT or management consulting experience. A master s degree may substitute for two years of the total four years required. A doctorate degree may
be substituted for an additional two years of related work experience.
Skills and Abilities
- Strong critical thinking, analytical and problem-solving skills are required.
- Requires experience building predictive models.
- Strong knowledge of outcome research design, controlled study design is preferred.
- Advanced knowledge of SAS including Enterprise Miner is preferred.
- Basic knowledge of United States healthcare delivery system in payer setting or provider setting is required.
- Must have strong knowledge of common query/analytic/visualization tools such as SQL, SAS, R, Python, Tableau, etc.
- Strong understanding of provider payment methodologies, population health management, and risk adjustments is desired.
- Strong understanding of clinical groupers including episode groupers and risk groupers such as DRG, APC, ETG, MEG, DxCg, and HCC is highly desired.
- Strong understanding of quality metrics (HEDIS, AHRQ) is desired.
- Knowledge of commercial risk optimization and MA risk optimization is a plus.
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Leads the selection of evaluation/analytics/BI methodologies and communicate recommendations to facilitate problem solving, solution development, decision making and strategic planning.
Appropriately leverages in-house clinical reporting software and models, Enterprise Data Warehouse (EDW) data sources and non-EDW data sources.
Independently facilitates business development and documents business problems and develops analytic solutions (i.e. Predictive model, BI solution, or analytic attributes).
Serves as the analytics advisor to collaborating departments on corporate and cross functional projects, reports and activities.
Independently translates business rules into analytical models and works as a liaison among healthcare analytics, Enterprise Information Management (EIM), IT and business areas.
Performs peer data quality reviews, validating data and process to ensure accuracy, completeness and consistency of department output.
Independently performs descriptive and analytic studies using advanced analytical/statistical techniques.
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