Responsibilities:

• Develop operational reports that allow management to effectively manage the business.
• Work with internal stakeholders to determine appropriate information for corrective action management reports.
• Evaluate current systems against new business needs; gather and document business requirements; ensure innovative, efficient solutions delivered are designed to meet business needs.
• Develop, implement, and maintain leading-edge analytic systems, taking complicated problems and building simple frameworks.
• Conduct and coordinate cross-functional analysis of health care data to identify trends, explain results, and discover opportunities for improvement.
• Create and maintain rich interactive visualizations through data interpretation and analysis integrating various reporting components from multiple data sources
• Communicate findings to clinical operations management and appropriate stake-holders.
• Design, develop, and implement ongoing data validation processes.
• Derive and validate universes required for quality monitoring and auditing, state, federal and accreditation audits.
• Identify areas for data quality improvements; help to resolve data quality problems through the appropriate choice of error detection and correction, process control and improvement, and/or process design strategies.
• Contribute to planning by determining what information is necessary to make valid decisions, generating the necessary information, and analyzing the information and making recommendations.
• Act as the liaison between Medical Management Operations and Technology to resolve production issues.
• Serve as subject matter expert in data/analytical related functions.
• May guide and mentor less experienced analysts.
• Develop standard and ad-hoc reporting and analysis as required.
• Perform other related projects and duties as required, directed, or assigned.

Qualifications:

• Bachelor s Degree in Actuarial Sciences, Decision & Information Sciences, Medical Informatics, Finance or related quantitative field; Master s preferred
• 5-8 years of experience in the design, development, and management of informational analysis tools required
• Previous work experience in utilization management and trend analysis, preferably within a managed care environment required
• Must have previous work experience in interpreting financial results and explaining variances required
• Ability to use raw data to create meaningful reports through working knowledge of relational database principles including SQL and MS-Office products (particularly MS-Access) required
• Experience with Tableau preferred
• Excellent quantitative and analytical skills required
• Knowledge of medical terminology and coding methodologies required. HCPC, CPT, RBRVS, Diagnosis (ICD-10), DRG's required
• Good oral and written communication skills with work experience in presenting analysis to key stakeholders to support strategic business decisions required
• Good project management skills required