Lead Data Analyst

Key Skills

Apache Hadoop, C Programming, C++, Data science techniques, Java Programming, Machine learning techniques, MapReduce, Python Programming, PyTorch, R Programming, Scala Programming, SQL, TensorFlow

Job Description

Position Purpose:

• Interpret and analyze data from multiple sources including claims, provider, member, and encounters data. Identify and assess the business impact of trends
• Develop, maintain, and troubleshoot complex scripts and reports developed using SQL, Microsoft Excel, or other analytics tools
• Lead the planning and execution of enterprise-wide projects and strategic initiatives, translating business goals into actionable solutions
• Identify and resolve data, process, and technical issues and communicate root-cause with stakeholders as appropriate
• Partner cross-functionally at all levels of the organization and effectively, both verbally and visually, communicate findings and insights to non-technical business partners
• Independently engage with business leaders to understand market-specific levers and constraints
• Leverage enterprise reporting tools to rapidly deliver data-driven insights and recommendations
• Research key business problems and proactively identify opportunities for cost and utilization improvements through quantitative analysis
• Communicate and present data-driven insights and recommendations to both internal and external stakeholders, soliciting and incorporating feedback when required
• Facilitate cross-team project collaboration between state-based health plans and business units, including IT, Finance, Network Development, and Payment Integrity
• Serve as a business leader and subject matter expert for data domains
• Consolidate and review analyses and recommendations of internal and external business partners
• Mentor junior analysts on analytic best practices and business need fulfilment. Delegate tasks to junior analysts, providing guidance and validation where required

The Data Analyst (Healthcare Analytics) will have the opportunity to make a significant impact through the discovery, development, and implementation of leading-edge analytics that answer important business questions. The analyst will collaborate with key corporate and health plan business partners for the purpose of identifying and delivering robust reporting and analytics capabilities to drive improved business performance.

Education/Experience:

Bachelor’s degree in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance or related field or equivalent experience. Master's degree preferred. 6+ years of experience working with large databases, data verification, and data management or 5+ years IT experience. Healthcare analytics experience preferred. Experience with table creation and indexing, query optimization, and utilization of stored procedures. Ability to integrate, validate, and reconcile data from multiple sources as well as design and construct analysis tools that extract, prepare, analyze, and store/present results to support business needs. Knowledge of query development using SQL or other coding languages. Experience in change management processes and procedures preferred. Knowledge of basic statistical, analytical, or data mining techniques including basic data modeling, trend analysis, and root-cause analysis preferred. Proven knowledge of analytical tools, including R, Python, SAS, ArcGIS, QGIS, Microstrategy, Tableau, Hadoop, or related tools preferred. Proven knowledge of relational databases preferred. Proven knowledge of automation capabilities such as batch processes, stored procedures, scripting languages, Microstrategy, or other tools preferred.

Provider

Experience in provider contracting, claims pricing, financial reporting/analysis, data modeling, statistical modeling, data science, or geospatial/reimbursement analysis preferred

Clinical

Experience in public health (biostatistics), population health, social determinants of health, data science, social science, or geospatial/ROI/financial analysis preferred

Finance

Experience working closely with accounting & finance business partners, using analytic techniques & tools to explore financial performance trends, or regulatory reporting with external agencies preferred; Familiarity with claims data, utilization, rate setting, risk adjustment, or member eligibility and reconciliation preferred

Fraud, Waste & Abuse

Experience in fraud/waste/abuse identification and investigation, provider billing, or clinical coding preferred; Experience with data mining, machine learning, artificial intelligence, or statistical modeling preferred

Risk Adjustment

Experience in risk adjustment, clinical coding, financial reporting/analysis, or CMS/State encounters and regulatory file submissions preferred; Experience with data mining, population health, and statistical modeling preferred

Quality

Experience with HEDIS, NCQA, Medicare Star Rating System, QRS, or other quality measures preferred; Quality auditing or analysis of call center performance preferred; Experience with data mining, population health, and statistical modeling preferred

Tools & Technology

Experience with report/dashboard development, data/report automation, self-service capabilities, data design and integration, or data quality and governance preferred