When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Under the general supervision of the Manager, Clinical Analytics, the Health Care Analyst is responsible for providing high quality analyses that answer questions about the most pressing healthcare needs and is comfortable utilizing various data modelling approaches to forecast future network’s performance. Interprets and provides recommendations on quality and cost utilization trends by identifying key drivers of performance. Is capable of writing appropriate drill down queries (SQL based queries) to identify opportunities for improvement. Assures, by data testing, the quality and accuracy of BILHPN’s claims and EMR data. Responsible for developing reports for upper-level management and preparing monthly reporting packages. Compiles medical, pharmacy and EHR related information via the use of computer-based applications which are then used to understand the current trends and drivers in the health care system and to make well-informed decisions about performance improvements of the plan and care management of the patients. Participates in setting definitions and efficient ways to analyze various healthcare concepts and promotes defining data related efficiencies. Handles the data with confidentiality especially around PHI and sensitive information.Job Description:
Essential Duties & Responsibilities including but not limited to:
Understands the medical and pharmacy claims adjudication circle terminology, healthcare quality and EHR terminology and general healthcare related concepts.
On regular basis, from analytical perspective, tests healthcare concepts in BILHPN’s data warehouse to assure accuracy and integrity of data.
Collaborates with other analysts and contributes/leads the process to define appropriate mappings for healthcare terminologies to be displayed in the data warehouse.
Understands and utilizes back-end entry to data warehouse, knows SQL and apprehends complexities of data architecture.
Designs and performs complex analyses for variety of stakeholders within BILHPN and network using either the super pivots, running own SQL queries to drill through data or other computer-based applications.
Translates analytical findings into easy-to-follow recommendations and summaries.
Performs own quality checks on performed analyses and utilizes internal benchmarks to verify the results. Documents performed processes and assures the correct documentation exists in the reporting documentation repository.
Collaborates with the Medical Director(s) and business associates (e.g., healthcare plan, PBM, consultants) to define the best approaches to find areas for improvement and trend mitigations.
Serves as analytical resource and internal consultant for organization’s multidisciplinary quality and utilization improvement initiatives.
Upon discussions with other stakeholders, provides actionable data and models the impacts of various opportunities (such as cost savings opportunities) for BILHPN’s population.
Assists in reporting package preparation for the Local Care Units’ Leadership and Board of Directors.
Collaborates with others to identify, understand and promote opportunities to analyze data more efficiently and accurately, and improve data integrity.
Uses visualization tools to display data for key customers.
Works independently and can handle multiple projects simultaneously with little supervision.
Organizational Requirements:
Maintain strict adherence to the Beth Israel Lahey Health Performance Network (BILHPN) Confidentiality policy.
Incorporate BILHPN Standards of Behavior and Guiding Principles into daily activities.
Comply with all BILHPN Policies.
Comply with behavioral expectations of the department and BILHPN.
Maintain courteous and effective interactions with colleagues and patients.
Demonstrate an understanding of the job description, performance expectations, and competency assessment.
Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
Participate in departmental and/or interdepartmental quality improvement activities.
Participate in and successfully completes Mandatory Education
Perform all other duties as needed or directed to meet the needs of the department.
Minimum Qualifications:
Education:
Requires a minimum of a Bachelors’ degree. Prior experience from the payers or other provider system a plus.
A master’s degree in directly related program may be considered in lieu of some of the required work experience.
Licensure, Certification & Registration:
None
Experience:
A minimum of 3-5 years of healthcare work experience is necessary either through a prior Health System or a Payer experience. Knowledge of programming language (e.g. SQL) is required, experience of Epic/Healthy Planet, data visualization tool of Power BI or Tableau is a plus
Skills, Knowledge & Abilities:
Strong written and verbal communication skills, project management skills, computer skills, and database skills.
Strong problem-solving abilities and analytical skills to ensure end-user needs are met.
Possesses good organizational skills and the ability to multitask and prioritize daily assignments to ensure smooth workflow.
Advanced Excel Skills demonstrated ability in using query tools and relational data bases such as SQL.
Data visualization Skills demonstrated ability in using Power BI or Tableau.
Knowledge of claims-based health care data, including medical terminology and standard coding systems (ICD9, ICD10, CPT, MS-DRG, etc.), HEDIS.