Job Code: 001650 Union Status: Non-Union Supervision: No FLSA Status: Exempt
POSITION SUMMARY The Healthcare Data Analyst works with the Director of Healthcare Informatics to utilize healthcare databases to answer a wide range of questions originating from various Company business units. The position will require the ability to produce analyses needed to identify opportunities to improve operations, control healthcare costs and utilization, and maximizing healthcare clinical and program outcomes.
REQUIRED RESPONSIBILITIES Required Responsibilities % of Time • Research and Development: • Develop reports, data analyses and studies to provide insights into Business Operations, Company Strategy and annual Business Plans. • Work independently and collaboratively with stakeholders in the Division by designing and executing ad hoc reports using claims experience and other data sources to support: • Provider profiling and network development. • Pharmacy management. • Population-health and care management. • Customer service operations. • Work with stakeholders in the Division to develop decision-support tools. • Aid Directors/Managers across the Company with implementation and tracking key quality metrics and sentinel events. • Elicit business and functional requirements by identifying and organizing desired outcomes and key performance indicators. • Develop and provide reports with mathematical and statistical validity. • Create new analytic processes, predictive modeling, and machine learning techniques applied to the Company data. • Ensure analytical reports and outputs are consistent with the enterprise; verify the accuracy, integrity, and relevance of the required data. • Provide database observations and recommendations to the Director (as well as other division management) to improve Company operations and cultivate continuous process improvement. • Share expertise with and train other staff on data issues, interpretation, and reporting tools. • Complete other analyses and studies related to Healthcare as directed. 60 • Analyze and Report: • Provide complete, thoughtful, and compelling evaluative information through peer collaboration and independent research, compilation, and analysis of data. Evaluate health care administrative data in order to identify cost, quality, and utilization trends. • Identify variability in health care cost and outcomes. • Develop and evaluate care and population-health management programs. • Provide reports and recommendations to management that result in effective relationships with providers, convenient access to high-quality and cost-effective care for members, and favorable and competitive financial agreements for services. • Provide reports and recommendations to staff to facilitate quality improvement, care management, population health initiatives, program development, process improvement, and staff efficiency. 40
REQUIRED QUALIFICATIONS • Master’s degree in Healthcare Informatics or other related field or commensurate experience. • Minimum of 2-3 years of experience working in health insurance or health care. • Minimum of 4-6 years of experience in data extraction from multiple data sources and reporting. • Expert knowledge of: • Health insurance operations, managed care practices, and insurance terminology and concepts; and health care data analysis and reporting health claim grouping methodologies (e.g. ETGs, DRGs, MEGs and more). • Evaluation and Statistical methods, including determining appropriate study design, statistical methods, visuals and verbal content to support findings and conclusions. • Analytic and reporting methods, tools, and procedures, including SQL, SSRS, Power BI and statistical packages. • Knowledge of using the Internet for research, and strong skills in using Microsoft applications including Word, Excel, PowerPoint, and Access. • Understanding of Relational databases and the ability to query data from them. • Excellent performance in present and past positions.
REQUIRED SKILLS • Verbal and written communication skills, including the ability to negotiate and compose clear, concise correspondence, internal policies and procedures, and narrative reports. • Excellent analytical skills, including the ability to identify problems, research and analyze issues from different perspectives. • Ability to use reporting software and tools to produce accurate and meaningful reports, and perform business analysis or process improvement. • Ability to work independently and to establish, monitors, and achieve goals with minimal supervision. • Ability to work as an effective team member with staff at all levels. • Ability to engage and interface with a broad and diverse set of internal and external stakeholders, such as business owners of data, operational or system data stewards, various analytical and reporting end-users, and Information Systems representatives across the range of data architects, developers, and system analysts. • Ability to be composed and adaptive in a dynamic, fast-paced, customer-focused work environment characterized by rapid change, minimal lead times, and multiple competing priorities. • Results driven. • Personable and ability to work well with others. • Accountable, open, candid and transparent. • Commitment to excellence in customer service and the Company's cultural and other values. • Commitment to achieving the Company's key results.
WORK REQUIREMENTS • Ability to work in typical office conditions with frequent use of computer equipment. • Flexibility to work the number and schedule of hours needed to accomplish regular and ad hoc job responsibilities.
PREFERRED QUALIFICATIONS AND SKILLS • Expertise in the Company's plans, policies, claims processing, customer service, and grievance and dispute resolution procedures and the concepts and terminology associated with group insurance contracts, laws, and regulations. • Thorough understanding of the Company’s member demographics. • Mathematic, statistical, and predictive modeling theory and tools (SAS-Stat, Python, R, etc.). • Knowledge of provider reimbursement methodologies, including evolving innovations in reimbursement models and emerging industry trends. • Knowledge of population health concepts, including evolving care management programs and drivers of change in health status for chronic disease populations.
Internal Number: 1565
Founded in November 2018, NeuGen is a Shared Services organization based out of Madison, Wisconsin. In 1970, the not-for-profit WEA Trust was founded by the Wisconsin Education Association Council (WEAC). Well known for high-touch, personalized customer service, WEA Trust serves Wisconsin public employers, their staff and families throughout the state. In 2018, WEA Trust acquired another Wisconsin-based health plan, Health Tradition, in order to serve both public and private employees in the state. Today, NeuGen supports both health insurance companies in addition to providing medical management and administrative services to other healthcare companies.