Performance Programs Data Analyst
Wage Range: $90,000/year - $100,000/year
The Performance Programs Data Analyst is accountable for developing data analysis strategies that delivers operational excellence, resulting in high performance in CMS Star and Medicare Risk Adjustment (MRA) program. To manage and coordinate organization-wide efforts to ensure that MRA/Quality and other clinical programs are developed and managed using a data-driven focus that sets priorities for strategic initiative. Support data analysis and data integration activities and processes that follow CMS, HPMS, NCQA, local, state, and federal regulatory guidelines. Manage the MRA Sweeps and encounter data submission activities along with assisting annual HEDIS submission for Managed Care Organizations, Medicare Star, HOS, CAHPS, and other regulatory and contractual compliance. Ensure cross-functional collaboration that meets the accurate appropriate codes submission goal and also improves quality of care delivery, member experience and outcomes.
Functions Job Responsibilities
- Apply technical skills to design, develop, and generate MRA/Stars/HEDIS production and similar reports. Maintain the SQL database to house underlying data to perform complex data analysis and data integration for various projects. Render the simplified information from the analysis into a user-friendly format or application (preferably BI) for discussion around strategy development.
- Perform strategic data analysis utilizing database query expertise to support business needs; understand business processes to effectively determine data analyses parameters, design, and reports.
- Assist with data and information gathering for targeted projects by cleaning and organizing data; querying, merging, and extracting data across sources; completing routine data refresh and update; and providing user support and documentation.
- Design, analyze, enhance, maintain, and monitor MRA/Quality/Clinical services metrics.
- Serves as liaison between Corporate IT and department regarding reporting/data needs.
- Collaborate with healthcare teams to identify areas of improvement, collect, and analyze data to identify trends and areas for improvement, and ensure compliance with regulatory requirements and standards of care.
- Deliver robust, integrated trend analyses, as well as produce ad hoc results for projects and programs.
- Manage reporting and analysis of various quality, retrospective and prospective vendor programs and IPA/MSO/PCP level metrics.
- Identify operational improvement opportunities through observation, data analysis, or other means, and leading multidisciplinary teams to achieve improvements.
- Assist with the scoping for improvement initiatives, acquiring stakeholder buy-in and leadership support, and establishing metrics and milestones.
- Perform independent complex data analysis to support leadership decision making
- Other duties as assigned.
Education and Experience:
- Bachelor's Degree in Healthcare, Math, Economics or Information Systems related field.
- 5 years of experience utilizing analytical skills and experience with data analysis, reporting, and forecasting.
- 3 years of experience of SQL and SSRS report development
- Strong knowledge of relational database and SDLC concepts.
- Experience with BI tool or front-end report generation tool.
- Medicare Risk adjustment and quality/Stars experience strongly preferred.
- Understanding and conducting analyses of multiple data sources and formats is strongly preferred.
- Expert database query skills to extract and consolidate data is strongly preferred.
- Expert level spreadsheet and database skills is strongly preferred.
- Knowledge, understanding, and accurate interpretation of product line related specifications, methodologies, and processes, and of MRA/HEDIS/Star processes.
- Excellent leadership skills and the ability to influence line management decisions with data driven facts.
- Strong management, problem solving, priority setting skills.
- Strong independent decision-making skills
- Strong organizational skills including time and project management skills.
- Computer proficiency in MS Office applications (word processing, spreadsheet/database, presentation)
- Possess strong results-oriented process improvement capabilities.
- Strong problem solving skills to be applied to a wide array of business problems and challenges.
- Solid change leadership, facilitation, oral and written communication, and presentation skills
- Detail oriented with exceptional written and verbal communication skills.
- Ability to maintain composure and effectiveness in a rapidly changing environment with minimum direction.
- Ability to work independently and as part of a team.
- Must be a self-starter and independent thinker.
Physical Working Environment.
Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:
- Must be able to travel when needed or required
- Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
- Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.
Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.
Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.