Our Cost of Care Analytics team is responsible for leading and developing medical cost reporting and analysis activities within the Medicaid Business Unit. The team consists of subject matter experts providing insights on medical expense trends and provides analytic support to Medical Directors and Enterprise Program leaders in developing programs and initiatives related to medical utilization.
We are seeking an experienced professional to support the following functions:
This position will be an internal customer facing role supporting the business in developing enterprise-wide medical cost reporting and analysis activities.
- Serve as the point of authority in the analysis of complex health care issues, including analysis of both health care utilization and cost metrics, complex financial analysis and development of advanced analytic outputs and/or services, as required.
- Responsible for overseeing the development of analytic narratives that include executive summaries, significant findings, conclusions and recommendations for action
- Functions as a liaison between own department, health plans, the Care Management team and other functional areas
- The ideal candidate will have experience in healthcare informatics and analytics, specifically experience in analyzing claims data and the development of program specific to a Medicare/Medicaid population.
Primary duties may include, but are not limited to:
Position requires knowledge of
- Performs established analysis for routine diagnoses of, use, cost, unit-cost and other variables for opportunity assessments;
- Advanced knowledge and skills as a subject matter expert in health data analysis as well as financial analysis ;
- Able to develop creative strategies and tap the creative potential of individuals and groups;
- Performs defined analyses to assess proper outcome metrics for various programs/initiatives;
- Builds, tests, and validates statistical models under supervision;
- . Recommends and implements improvements to existing procedures. Influences others to follow existing procedures.
- Understands the pitfalls and limitations with analyzing practical data and the ability to ensure data and analysis quality.
. Individual will be required to solve well defined analytical problems independently; delivers assignment/projects timely and accurately; collaborates with other analytical team members effectively; presents
- General healthcare, who are our providers (hospitals physicians, ancillary providers) who are payors (insurance companies),
- High level claims process, knowledge of general industry how it works, including HIPAA.
- More specific knowledge around reimbursement methodology, fee schedules, per case, per diem, DRG, % of charges.
- Specific knowledge of code sets such as revenue codes, procedure codes (CPT4, HCPCS, ICD9/10), Diagnoses --Related Grouping DRG codes, place of service codes (POS),
analyses effectively to analytical and business audience; possess strong intellectual curiosity and motivated to master analytical skills.
Advanced Analytics Analyst Consultant level r equires Graduate-level degree with concentration in a quantitative discipline such as Mathematics, Statistics, Economics, Engineering, Computer Science or Operations Research. R equires 5-10 years experience in related health care analytics; or any combination of education and experience, which would provide an equivalent background.
Ideal candidates should have Intermediate ability to leverage available tools such as:
TOAD, Microsoft Project, Microsoft Office, Microsoft query analyzer SQL mgr, Teradata, SAS, VISIO, (Google), Internet Search, Internet research, use and understand gene rally accepted templates and BA tools.
Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).
associate referral process on WorkNet. Official guidelines for the associate referral
- Current WellPoint associates: All referrals must be submitted through the formal
program can be found in My HR.
Similar Job Postings
- WARNING : Please beware of phishing scams that promote work-at-home opportunities and may also pose as legitimate companies. Please be advised that a WellPoint recruiter will never ask you for a credit card or any type of payment as part of consideration for a role with our company. All of our careers require that you first complete an online application on our wellpoint.com/careers web site.
Information Mgmt Consul...
Advanced Analytics Anal...
Advanced Analytics Sr A...
WFM Analyst (Richmond, VA)
Workforce Service Level...
WellPoint - 6 months ago
WellPoint, Inc. (WellPoint) is a health benefits company serving 35 million medical members, as of December 31, 2008. The Company is an...