Provide data analysis for PacificSource to achieve the goals and initiatives identified in our Strategic Plan. Participate in the development, implementation, and evaluation of strategies to control health care costs and improve quality. Partner with Health Service and Provider Network related to identification of opportunities to optimize the delivery of health care, including but not limited to alternative provider reimbursements, disease management, wellness programs and early identification of high risk populations and overused procedures. Represent AUA to internal and external customers and participate in industry-leading research and development in the fields of transparency and reimbursement transformation.
Participate in the development, implementation, and evaluation of strategies to control health care costs. Develop analyses to evaluate new program features including testing and implementation of new clinical programs.
Partner with internal departments, such as Health Services and Provider Network, related to data analysis and strategy development and achievement.
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.
Analyze, prepare presentations, and present data analysis reports and findings to external customers and internal departments. As required, act as project manager for multi-disciplinary analytical work.
Provide peer review of AUA analytics.
Support 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 or SPSS.
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 and perform other duties as assigned.
Perform other duties as assigned.
Work Experience: Three to five years’ experience in medical/health insurance or population health required and demonstrated by business experience with analyzing data.
Education, Certificates, Licenses: Bachelor's degree in Mathematics, Statistics, biostatistics, epidemiology or similar research related field or equivalent work experience required.
Knowledge: Knowledge of health plan cost containment strategies including medical management interventions provider contacting methodologies, and benefit design alternatives is essential. Strong knowledge of provider agreements and provider contracting is preferred. Experience with financial modeling tools required and predictive modeling tools and program evaluation a plus. Knowledge of provider payment structures and state and federal regulatory agency policies and procedures required. Familiarity with NCQA is helpful but not a requirement. Proven ability to perform difficult analytical tasks with minimal supervision. Working knowledge of medical costs is desired, while experience with medical coding and terminology is also preferred. 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.
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 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 - 12 months ago
PacificSource Health Plans is anything but a typical health plan. We’re a growing, independent, not-for-profit organization with a...