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Health Care AnalystJob ID 146355 Date posted 05/15/2018
Under the general supervision of the Director, Data Performance and Analytics, the Healthcare Analyst is responsible for understanding the various data sources behind organizations population and learns how to effectively and accurately use these sources to produce meaningful cost and utilization summaries. Produces analyses that answer questions about most pressing healthcare needs and occasionally assists care management with the management of the riskiest patients within the populations. Assures, by data testing, the quality and accuracy of LCPNs claims and EMR data warehouse. Understands data complexity and requirements to produce analyses for various cross-departmental stakeholders from Lahey Health that answer questions to the most pressing healthcare needs. Responsible for developing reports for upper-level management, and preparing monthly reporting packages. May be asked to develop enhanced reports for the organization. May work under the supervision of the Senior Healthcare Analyst.
Compiles medical and pharmacy related information via the use of computer-based applications which is then used to understand the current trends and drivers in the health care system and to make well-informed decisions about performance improvements of the plan and care management of the patients. Supports care managers in providing better care to the patients. Participates in setting definitions and efficient ways to analyze various healthcare concepts, compares medical expenses to budgets, and assists in finding data related efficiencies. Handles the data with confidentiality especially around PHI and sensitive information.
This position is responsible for a full range of activities which ensure the analytical effectiveness and excellence of the LCPN team.
Essential Duties & Responsibilities including but not limited to:
1. Gains access and learns the tools used to access populations data.
2. Understands the medical and pharmacy claims adjudication circle terminology and general healthcare related concepts.
3. On regular basis, utilizes different data sources to produce meaningful cost and utilization reports, track the performance of various products and plans and provide meaningful information to care managers to assist them in providing better care to the patients.
4. On regular basis, from analytical perspective, tests healthcare concepts in LCPNs data warehouse to assure accuracy and integrity of data.
5. Collaborates with other analysts to define appropriate mappings for healthcare terminologies to be displayed in the data warehouse.
6. Understands and utilizes back-end entry to data warehouse, knows SQL and apprehends complexities of data architecture.
7. Produces reports for variety of stakeholders using either the super pivots, running own SQL queries to drill through data or other computer-based applications.
8. Translates analytical findings into easy to follow recommendations and summaries.
9. Performs own quality checks on performed analyses and utilizes internal benchmarks to verify the results.
10. Incorporates CHIA cost relativity benchmarks into analyses when appropriate.
11. Documents performed processes and assures the correct documentation exists and is appended to the analyses.
12. Collaborates with the Medical Director(s) and business associates (e.g., healthcare plan, PBM, consultants) to define the best approaches to find areas for improvement and trend mitigations.
13. Collaborates with Care Managers to find efficient ways to include the patients in the disease management programs and improve the care of the patients.
14. Has knowledge of a medical and pharmacy claim cycle.
15. Analyzes cost and utilization trends at the network level.
16. Receives and reviews administrative payers newsletters and assesses the impact of changes on the network and data when necessary.
17. Understands the drivers of healthcare trends.
18. Understands the impact of benefit changes on the plan performance.
19. Serves as analytical resource and internal consultant for organizations multidisciplinary quality and utilization improvement initiatives.
20. Upon discussions with other stakeholders, provides actionable data to constituencies within LCPN upon request.
21. Designs analyses that calculate cost savings opportunities for LCPNs population.
22. Communicates effectively with cross-functional teams.
23. Provides clinical and administrative leaders with routine and timely updates on key clinical quality and utilization indicators at the network level.
24. Assist in reporting package preparation for the Board of Directors and other Senior Executives.
25. Assist in designing analyses that calculate cost savings opportunities for the network as well as individual accountable care units.
26. Collaborates with others to identify, understand and promote opportunities to analyze data more efficiently and accurately, and improve data integrity.
27. Assists Data and Performance Analytics Director with keeping internal PointShare site up to date.
28. Supports vendor pilot programs via assessing and distributing reports made available by the partners.
29. Uses visualization tools to display date for key customers.
30. Performs other related tasks as necessary.
Incorporates Lahey Health Guiding Principles, Mission Statement and Goals into daily activities.
Complies with all Lahey Health Policies.
Complies with behavioral expectations of the department and Lahey Health.
Maintains courteous and effective interactions with colleagues and patients.
Demonstrates an understanding of the job description, performance expectations, and competency assessment.
Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
Participates in departmental and/or interdepartmental data quality improvement activities.
Participates in and successfully completes Mandatory Education programs.
Performs all other duties as needed or directed to meet the needs of the department.
Requires a minimum of a Bachelors degree. Prior experience from the payers or other provider system a plus.
Licensure, Certification & Registration: None
A minimum of 1-3 years of healthcare work experience is necessary either through a prior Health System or a Payer experience. Knowledge of programming language (e.g. SQL) is beneficial but not required. A Masters degree in a directly related program may be considered in lieu of some of the required work experience.
Skills, Knowledge & Abilities:
Strong written and verbal communication skills, project management skills, computer skills, and database skills.
Strong problem solving abilities and analytical skills to ensure end-user needs are met.
Possesses good organizational skills and the ability to multitask and prioritize daily assignments to ensure smooth work flow.
Advanced Excel Skills, demonstrated ability in using query tools and relational data bases such as SQL or Microsoft Access.
Knowledge of claims based health care data, including medical terminology and standard coding systems (ICD9, ICD10, CPT, MS-DRG, etc.
About Lahey Health
The Lahey Model of Care - right care, right time, right place - is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.
Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.
How To Apply
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