[Hiring] Population Health Data Senior Analyst @American Addiction Centers

Role Description

This individual will be responsible for analyzing complex clinical and financial (claims-based) scenarios to support informed decision making. This person works relatively independently with limited direction and supervision. Responsible for gathering and interpreting claims, clinical and administrative data to build effective financial models, make reasonable assumptions, and reach appropriate conclusions. Serves as a resource and consultant across the system and sites to design and produce relevant information to inform strategies essential to the success of population health initiatives.

Major Responsibilities

• Prepares analyses and develops routine and special management reports and reporting tools to support ongoing PHO, CIN, RBO operations, finance, care management, clinical risk adjustment, and department management decision making.
• Works with administrative and physician leadership (site and system).
• Analyze the total cost of care and payer contract performance using any and all data systems available.
• Makes specific recommendations to management and physician leadership (site and system) based on the results of these analyses.
• Analyze clinical, financial, and quality performance by site, physician, and contract.
• Proactively identify areas for analyses and share information with physician and administrative leadership.
• Conduct and present analyses that drive improved delivery of value-based care.
• Works with IT partners to diagnose, correct, and validate any issues with the data populating business intelligence tools.
• Creates efficient presentations of quantitative and qualitative information by minimizing text and appropriately incorporating visual displays.
• For executive level reports, craft a concise written summary of key report conclusions and clearly translate analyses and visualizations into practical and actionable recommendations.
• Summarizes analytical findings in ways that business leaders and front-line clinicians can quickly understand and use to drive performance improvement.
• Assumes responsibility for maintaining current knowledge of government regulations, policies, and trends that affect the health care industry, and independently conduct online research to access documents, pertinent regulations, or to access publicly available datasets.

Qualifications

• Bachelor's Degree in Accounting, Business, Health Care Administration, Computer Science or related field.
• Typically requires 5 years of experience in clinical data analysis or analytics experience in health insurance or healthcare fields.

Requirements

• Must have strong analytical skills, advanced Microsoft Office Suite skills specifically in Excel and PowerPoint, and be able to communicate effectively with management and staff at all levels.
• Advanced analytical skills, including the ability to analyze quantitative and qualitative data and reach sound conclusions.
• Advanced computer skills, including Microsoft Office Suite; especially Excel.
• Experience with one or more business intelligence tools, preferably Power BI.
• Good communication skills, including verbal communication and business writing.
• Working knowledge in the healthcare insurance industry, healthcare finances, care management, clinical risk adjustment, and/or physician practices.
• Good project management and time management skills.
• Good interpersonal skills, including the ability to communicate at all levels within the organization.
• Experience with EMRs (Electronic Medical Records) preferred.
• Experience and ability to create complex queries in SQL or other query languages.
• Ability to code in Python preferred.

Additional Skills and Experience

• Strong understanding of Managed Medicaid concepts including utilization management, quality measurement, risk stratification, benchmarking, and cost containment.
• Familiarity with healthcare data types including claims, pharmacy, laboratory, ADT, and standardized clinical ontologies.
• Demonstrated experience supporting application testing, implementation, training, and ongoing operations in a healthcare environment.
• Experience with care management or population health platforms strongly preferred.
• Experience with DHHS data and NC Medicaid program requirements preferred.

Medicaid Specific Work

• Develop and execute SQL queries for data extraction, analysis, and reporting using Power BI and other BI tools.
• Propose design and technical solutions to improve Managed Medicaid applications, processes, and workflows across the program.
• Provide end-to-end application support for systems critical to Managed Medicaid operations, including care management, pharmacy, quality, and population health data platforms.
• Continuously monitor Managed Medicaid applications and dashboards to ensure data integrity and compliance with program and state regulatory standards.
• Manage and resolve application issues affecting Managed Medicaid workflows; serve as the primary vendor contact and first point of escalation for helpdesk tickets.
• Administer application security controls to protect beneficiary PHI; support payer and DHHS audit preparation with timely, accurate data submissions.
• Write and execute test plans for new application releases, bug fixes, and enhancements; communicate changes to internal and external stakeholders.
• Develop and maintain application documentation, own subject matter expertise on Managed Medicaid platform functionality and product roadmaps.
• Build and maintain vendor relationships; collaborate on root cause analyses and proactively mitigate risk of issue recurrence.

Physical Requirements and Working Conditions

• Position may require some travel. May be exposed to road and weather hazards.
• Generally exposed to normal office environment.
• Operates all equipment necessary to perform the job.
• Fully Remote Role from specified states.
• Due to complex requirements, remote work is NOT permitted for certain states and working internationally.
• No relocation, No Sponsorship or transfer of visa for this position now or in the future.

Pay Range

$41.10 - $61.65

Our Commitment to You

• Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more.
• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training.
• Premium pay such as shift, on call, and more based on a teammate's job.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.
• Paid Time Off programs.
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.