Provide data analysis for PacificSource to achieve the goals and initiatives identified in our Strategic Plan. Primary subject of analytic support will be related to analysis of cost and utilization of health services, in support of large employer reporting, financial modeling for provider contracting analysis, and identification of opportunities and evaluation of health services activities, including, but not limited to, disease management, wellness programs, and early identification of high risk populations. Analytical role may vary and involve knowledge of contract language, healthcare utilization, performance analysis for clinical programs, state and federal guidelines.
Perform accurate and complete data extraction from claims data warehouse, including medical, pharmacy and laboratory data sets, to meet project requirements.
Analyze health care data, utilization, quality initiatives, outcome, and performance analysis for clinical programs.
Assist in the development, implementation and evaluation of disease management and pharmacy management methodologies across diseases. Develop analyses to evaluate new program features including testing and implementation of new clinical programs.
Prepare and analyze regular cost and utilization reporting for large external customers, including interpretation of results and recommendations to improve performance through benefit, disease management, and other program changes. Work with underwriters to prepare employer presentations.
Serve as lead for the monthly reports produced in AUA by owning the project and coordinating with all contributors. Facilitate the meetings related to the monthly reports.
Support of provider contracting through analysis of cost and utilization and modeling of new contractual provision.
Provide information and support for ad hoc analytic projects for internal customers.
Gather and generate information used to understand health costs and assist with making recommendations to health plan on cost analysis.
Work with very large data sets and performs statistical analysis and modeling techniques, including the use of standard statistical packages such as SAS, SPSS, or KXEN.
Perform data analytics including standard deviation, downside risk etc. as well as utilize index characteristics.
Assist in the development of capabilities and performance measurements.
Respond to ad-hoc analytic requests.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience: Three to five years experience in medical/health insurance is preferred as is demonstrated by business experience with analyzing data. An understanding of healthcare data trends and experience with financial modeling tools is essential. Experience with predictive modeling tools and program evaluation a plus. Familiarity with NCQA is helpful but not a requirement.
Education, Certificates, Licenses: Bachelor's degree in Mathematics, Statistics, Public Health or similar research related field or equivalent work experience required.
Knowledge: Working knowledge of medical costs is desired, while experience with medical coding and terminology is also preferred. Proven ability to manage multiple projects and competing deadlines. Ability to solve complex problems. Ability to deal responsibly with confidential information. Proficiency in SAS and other technical applications such as SQL, ACCESS, and web-based database tools. Skilled in Microsoft Office: Word, Excel, PowerPoint, Outlook. Ability to work in a team environment and manage multiple priorities.
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We encourage creativity, innovation, and the pursuit of excellence.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity and affirmative action employer.
PacificSource Health Plans - 4 months ago
PacificSource Health Plans is anything but a typical health plan. We’re a growing, independent, not-for-profit organization with a 78-...