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About
Essential Job Function Data Analysis & Performance Monitoring
Analyze claims, clinical, and operational data to assess performance in value-based contracts.
Monitor key performance indicators (KPIs) such as total cost of care, quality measures, risk scores, utilization, and shared savings metrics.
Respond to ad hoc value-based care analytics requests.
Quality & Outcomes Analytics
Measure and evaluate quality performance against HEDIS, STAR ratings, CMS quality programs, and custom metrics.
Collaborate with clinical teams to identify gaps in care and improvement opportunities.
Cross-Functional Collaboration
Supports work across a variety of teams and stakeholders.
Prepares components for reporting and presentations.
Education Required: Bachelor's Degree
Preferred: Master's Degree
Experience Required:
Minimum of 2 years of experience.
Formal training or work experience in data analytics, data analysis, or data science
Experience working with two or more healthcare data types including claims data, payor revenue/premium data, payor supplemental data, clinical data including clinical quality metrics (HEDIS) and risk adjustment (HCCs), social determinants of health (SDOH), and operational data and KPIs.
Proven experience using data and analytics tools. Deep experience using SQL and at least one analytics or visualization tool (PowerBI, Tableau, SigmaComputing, or other).
Ability to communicate analysis to peers and stakeholders.
Genuine curiosity to dive deep into healthcare data and uncover insights and root causes.
Deep commitment to continuous learning as part of a cross-functional team that includes clinical and non-clinical stakeholders.
Preferred Experience:
Experience working in modern data infrastructure (Snowflake or Databricks).
Experience providing analysis and analytics for value-based contracts* Experience working within an agile delivery environment (DevOps)
Experience working with healthcare payors (CMS, regional and national payors)
Knowledge of and experience with healthcare claims data and related claims analytics tools (such as Milliman's MedInsight, MedeAnalytics, Tuva or claims analytics tools)
Knowledge of and experience with electronic health records (EHRs, such as Epic, Cerner, eCW, Allscripts, Athena)
Understanding of clinical workflows and clinical operations as they relate to value-based care and population health
Knowledge of and experience with population health management platforms (such as Epic's Value Based Care, Innovaccer, Arcadia, Lightbeam or other care management or population health platforms)
Languages
- English
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