Healthcare Analyst

Job Description

Position summaryThe Healthcare Analyst provides clinical and financial analysis and reporting for the company s existing clients and provides support for pricing new business. Essential functions Acts with honor and integrity, serving as a role model for the company. Analyzes prospective and current client utilization data to identify utilization trends, calculate cost of healthcare and identify opportunities for New Century Health to add value to customers. Works with internal business customers to define report and dashboard requirements for use in managing day to day operations more efficiently. Assists with the QC/ Validation of the data currently being developed into the data warehouse. Validates the completeness of potential client data files using various techniques. Extracts and compiles both internal and external data elements used in all aspects of the business from client pricing, medical cost management, operational reporting and general financial analysis as required. Populates existing pricing model with potential client information and makes suggestions on potential improvements to the model or corresponding presentation/ reporting. Participates in or conducts presentations to prospective clients regarding New Century Health s pricing methodologies. Reconciles capitation payments to eligibility data to ensure monthly payments received are accurate. Calculates and analyzes monthly capitation payments made to network providers; identifies and investigates unusual fluctuations and determines root cause of potential problems. Conducts recurring and ad hoc provider utilization analyses; prepares meaningful, professional reports for health plans. Respects and maintains HIPAA confidentiality guidelines. Acts as an interdepartmental liaison between all New Century Health offices, departments, and committees. Performs other duties as assigned.Key competencies/ skill/ success factors: Work experience with line item healthcare claims and PBM information is preferred. Must have extensive knowledge of and experience with SQL An understanding of CPT, ICD- 9, Revenue and DRG codes is preferred. Must have expensive experience and proficiency leveraging SQL, including loading data, writing update and select statements, and joining tables. Experience with Excel spreadsheets and other office productivity applications to share and present analytic results. Experience with statistical analysis tools such as SAS. Experience with business Intelligence tools such as Ability to understand and work with a variety of data formats to create charts, graphs, tables, and other visual means of representing key aspects of the data. Strong written and verbal communications, including the ability to summarize the results of data analysis for technical and non- technical audiences. Must also be comfortable presenting this information via in person meetings as well as webinar technologies. Experience with technical writing preferred. Must have strong analytical skills with the ability to develop advanced analytic models (e.g. forecasting). Must be skilled at prioritizing assignments and working to ensure all mission critical timeframes and deadlines are met. Must be able to work independently and demonstrate initiative and problem solving skills working within a fast paced start up environment.Qualification and Experience: Required At least a Bachelors degree with emphasis in Economics, Computer Science, Statistics, Math or Business, or equivalent work experience. Minimum of 2- 4 years work experience in an analytical role. Master degree in a quantitative field preferred.Big plus NA Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position primarily works in a climate controlled based setting.The noise level and the work environment are moderately quiet. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines Physical demand: Include the physical demands of the job, including bending, sitting, lifting and driving. For example, while performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.,

Keyskills :
statistical analysis toolsbusiness intelligence tools root causerole model music makingdata analysis cost managementtechnical wr