PRIMARY FUNCTION
The Analyst, Healthcare Analytics is responsible for developing membership, panel management, quality metric, cost and utilization reports. This role will require collaboration with cross-functional teams, including clinical, FP&A, managed care, and operations, to provide insights into underlying trends, support sizing operational improvements, and measuring the financial return.
ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
Gather and process attributed member, patient, quality metric, cost and utilization data from various sources including from payers and from Pediatric Associates internal data sets. Analyze attributed membership, patient, quality metric, cost and utilization data at various reporting grains to identify trends, patterns, and areas for improvement in overall panel and contract management. Review and interpret contract language to ensure that the corresponding financial terms are applied correctly for reporting and analysis. Prepare and present reports and visualizations to communicate findings and insights to stakeholders. Collaborate with cross-functional teams to understand business needs and translate needs into data analysis projects. Prioritize requests and execute assigned projects, ensuring timely completion and accurate results. Partner with data organization to ensure data is available to enable analysis and reporting, identification of trends and underlying drivers.
QUALIFICATIONS
EDUCATION: Bachelor’s Degree in Statistics, Healthcare Economics, Business, Healthcare Administration, or equivalent combination of education and work experience required.
EXPERIENCE:
- A minimum of 2 years of healthcare analytic professional experience required.
- 4 years of experience in healthcare analytics preferred.
- Experience integrating clinical data (EMR) with payor data preferred.
- Experience using healthcare eligibility, quality and claims data sets and how those data sets join preferred.
- Experience reviewing and interpreting contract language and connecting contract language to healthcare data sets preferred.
- Experience in Managed Medicaid preferred.
KNOWLEDGE, SKILLS AND ABILITIES
Required qualifications:
- Analytical and problem-solving skills with expertise in data mining, statistical analysis, and data visualization tools.
- Proficiency in data analysis tools (e.g., SQL, SAS, R) and database management systems.
- Ability to prioritize projects and tasks to meet deadlines.
- Understanding of business processes and how data can be used to drive decision-making and improve performance.
- Written and verbal communication skills to effectively convey findings and recommendations to both technical and non-technical audiences.
TYPICAL WORKING CONDITIONS
- Non-patient facing
- Full time remote
- Job must be U.S. based
OTHER PHYSICAL REQUIREMENTS
- Vision
- Hearing
- Sense of Touch
- Manual Dexterity to operate a computer
PERFORMANCE REQUIREMENTS
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.
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