Working under the direction of the Manager, the analyst will be responsible for financial analytics and a robust understanding of Harvard Pilgrim Health Care’s medical cost trends and financial performance as compared to plan-wide and provider budgets. Will possess in-depth health care reimbursement and managed care business knowledge with specialized technical and analytical skills. The analyst will be responsible for managing analyses from the conceptualization phase to conclusion. This position will be responsible for supporting provider related financial and corporate decision making at all levels of Harvard Pilgrim Health Care. Analyses will primarily focus on provider medical cost and utilization trends, provider contracting negotiations, competitive cost analyses, as well as alternative provider reimbursement and financial modeling. May be asked to serve as project manager and/or lead cross-functional teams.
Must have experience manipulating and analyzing claims data and be familiar with provider reimbursement terms and concepts. Must have a strong understanding of SAS or other programming languages (SQL). Must be proficient in Microsoft Access and Excel. Strong interpersonal skills and the ability to work in a team environment required.
ESSENTIAL FUNCTIONS :
Responsible for designing and generating various HPHC reports and financial analytics that focus on medical cost, utilization, membership, trends, and ad hoc requirements. Based on detailed analytics, create actionable information that results in identifying trends and opportunities for improvement in HPHC and provider performance.
Must demonstrate ability to translate complicated and technical analytics into concise and easily understood recommendations.
Work independently and/or lead a team of analysts to identify and present cost avoidance and cost recovery opportunities.
Perform financial & utilization analytics required by other departments within HPHC including Medical Management, Contracting, Payment & Policy, etc.
Translate customers (both internal & external) needs/expectations into technical specifications allowing for efficient and accurate analytics.
Utilizing in depth understanding of reimbursement methodologies and trends in managed care finance. Lead the development and analysis of new reimbursement strategies and financial analytics supporting provider contracting in the HPHC network.
Responsible for ongoing communication with customers, providing project status updates, resolving issues, coordinating continued involvement to meet jointly agreed upon expectations.
Serve as a team/project leader and train other staff in applicable areas of demonstrated expertise.
MINIMUM REQUIREMENTS :
Ability to use the fundamental concepts, practices and procedures of financial data/medical claim analysis is required
Bachelor’s in Business Administration, Finance, Health Services, Masters degree preferred.
7+ years business experience, preferably in a managed care provider environment in the Connecticut market.
Ability to work independently
Must be able to work in team environment to reach goals and objectives.
Must be skilled at manipulating and analyzing large claims and financial databases.
Must possess in depth knowledge of provider reimbursement terms and concepts.
Must have base knowledge in SAS or other programming language (SQL).
Must be advanced in the use of Microsoft Access and Microsoft Excel.
Strong written and verbal communication skills required.
Harvard Pilgrim Health Care - 20 months ago
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