Job Description

JOB DESCRIPTION: The Health Care Economics Analyst is responsible for data quality review, mining, analysis, program and project management, and reporting of health care information. This reporting will support both internal and external activities, such as margin enhancement initiatives, cost of care analysis, exchange of clinical data with providers, vendors, or regulators, provider network assessments, and health improvement programs.

ESSENTIAL JOB DUTIES:

• Works with management and in cross functional work groups to develop and complete tactical plans and data analytics for health care programs and projects.
  • Data analytics and outreach for ACA risk and market stabilization programs
  • Quality department programs and projects including provider benchmarking and outreach
  • Provider network adequacy analyses
  • Margin Enhancement Initiative valuations, projection and outcome tracking (i.e. improving the company’s financial margins with specific initiatives aimed at cost savings, utilization reduction, and/or expense reduction while maintaining quality in members’ care and services).
• Evaluates data source quality and manages improvement projects focused on data and reporting quality improvements
• Analyzes and monitors claims data and resulting metrics
• Independently interacts with providers, vendors, or regulators on exchange of health care data
• Performs extraction and analysis of data from data warehouses and applications
• Identifies, outlines, and presents results of analysis to management

The statements contained herein describe the essential functions of this position. This description is not an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, subject to reasonable accommodation.

WORKING CONDITIONS

• Performs work in an office setting with moderate levels of noise, sitting for long periods of time, employing repetitive motion using computers and phones, and with exposure to fluorescent lighting. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subjected to bending, reaching, kneeling, stooping, and lifting up to ten (10) pounds.

EDUCATION / EXPERIENCE

• BA/BS or graduate level degree in math, statistics, or a related field. – required
• Five (5) years of related analysis experience – preferred
• Three (3) years of coding experience in a health care setting (ICD, CPT, E&M, HCPCS, DRG, etc.) – preferred
• Health care claims data analysis experience in a health plan environment – preferred
• Experience with claims records including service and/or diagnosis coding auditing – preferred
• Cost Accounting in health care – preferred

CERTIFICATIONS

• Certified coder – preferred
• Informatics certification – preferred

QUALIFICATIONS

• Experience with Microsoft Access, Excel, PowerPoint, Word
• High skill level in either Access or Excel
• Experience with query tools
• Ability to present ideas clearly and concisely to all audiences whether communicated verbally or in writing.

REPORTING RELATIONSHIPS

• Supervised By: Chief Informatics and Quality Officer
• Supervises: This position does not supervise subordinate staff.

SCHEDULE Full-time

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