Senior Health Care Data Analyst - Emblem Health

Summary of Position
Develop and execute sophisticated outcomes or impact studies evaluating data sets and individual health outcomes against Evidence-Based Medicine metrics for specified disease or pre-disease states and/other health care standards or care of utilization. Incorporate the use of industry standard metrics and analytics to develop and deliver complex analyses, reports, findings, and presentations resulting in the use of actionable information; identify trends, root causes, etc. Develop recommendations for improvements based on findings. Produce reports and provide analytics to validate program effectiveness for external clients of WellSpark Health.

Principal Accountabilities

• Design/develop state of the art impact studies that allow Wellspark to effectively demonstrate the value of our clinical and health programs, understand cost of care trend drivers (both retrospectively and prospectively), and implement a communication strategy that allows this information to be effectively distributed to all interested departments.
• Understand business needs, create and document the requirements to support the design and development of standardized and/or ad-hoc reports needed to thoroughly understand the product performance including DPP, Help 364 and Coaching for Life; and to support decision making.
• Conduct and coordinate the analysis of health care data to identify, demonstrate, and explain results; discover opportunities for plan improvement.
• Communicate findings to senior management and the appropriate stake-holders in a clear and concise manner; make recommendations to senior leadership based on analyses performed for improvements across our products and/or documentation.
• Acquire expertise in our internal reporting environments to be used as the source for most data analysis, studies, and customer reporting and contractual obligations.
• Develop and maintain a strong working relationship with customers, senior management and business leads across the company as well as with outside vendors to maximize and validate program effectiveness.
• Proactively work with other departments to become a business advisor on all assigned projects, analyses, etc. to optimize outcomes/impact studies and improve program effectiveness.
• Perform return on investment (ROI) evaluations and analyses for vendor programs as well as internal medical cost savings initiatives; work with vendors and/or business owners as necessary.
• Responsible for technical configuration of our primary clinical and documentation system: work with WellSpark business leads including Account executives, Clinical, and Health Coaching to support growth and changes to business.
• Contribute to planning by determining what information is necessary to make valid decisions, generating the necessary information, and analyzing the information and making recommendations.
• Design, develop, and implement statistically valid tests for internal and external assumptions for healthcare cost savings. Design methods and techniques that take into account the justifiable causes for variation in medical costs.
• (age, sex, illness, severity, etc.,) and develop reports that summarize this information in a way that management can use to make actionable decisions.
• Monitor and make recommendations for data capture and documentation processes and procedures across clinical staff to ensure critical data points are available for customer activity, outcome studies, and billing where appropriate.
• Work with internal stakeholders to determine appropriate formats, layouts and presentation of information for both internal and external consumption.
• Identify deficiencies in data quality and work cross-functionally to resolve them.
• Perform other related projects and duties as required or assigned.

Education, Training, License, Certifications
Bachelor's Degree, in Decision & Information Sciences, Medical Informatics, Healthcare, Finance or related quantitative field.

Relevant Work Experience, Knowledge, Skills and Abilities

• 5 - 8 years of experience in the design, development, and management of informational analysis tools. (R)
• In lieu of a Bachelors' degree and 5 years of experience as stated, we will accept a Masters' degree in one of the stated fields and 3 years of work experience and will view one year of Ph.D. studies as equivalent to each year of required work experience as stated on a one to one basis. (R)
• Previous work experience in cost of care and trend analysis required preferably within a managed care environment. (R)
• Must have previous work experience in interpreting financial results and explaining variances from budget to actual. (R)
• Ability to use raw data to create meaningful reports through working knowledge of relational database principles. (R)
• Proficient with MS-Office products (including expert level with database/spreadsheet tools). (R)
• Excellent quantitative and analytical skills, along with an exceptional attention to detail. (R)
• Knowledge of medical terminology, common health data analytics such as HEDIS, Evidence based medicine protocols required. HCPC, CPT, RBRVS, Diagnosis (ICD-10), DRG's. (R)
• Effective oral and written communication skills; experience in presenting analysis to key stakeholders to support strategic business decisions. (R)
• Effective prioritization, organization, and project management skills. (R)

Additional Information

• Requisition ID: 1000000577