SENIOR DATA ANALYST, INCENTIVE PROGRAMS - HIKINEX

JOB SUMMARY:

The Sr. Data Analyst of Incentive Programs' primary responsibility is the maintenance and enhancement of the database used to gather multiple sources of data and help the incentive programs department monitor the performance of each provider and member for HCC/RAF and quality related incentives. The incumbent will also manage the incentive program initiatives by managing the production of analytical reports on HCC/RAF and quality measures, outcomes, and research of additional data sources that could benefit those incentive programs. The Senior Data Analyst responsibilities will also include database maintenance, enhancement, conversion to SQL, analysis, and reporting of incentive programs, patient utilization of HCC/RAF and quality measures and their outcome within the health network, risk-bearing organizations, contracted health plans, and Medicare CMS.

KEY JOB FUNCTIONS & RESPONSIBILITIES:

• Access proprietary patient, clinical quality, and financial performance data from Data Warehouse and Enterprise Data Systems for use in analysis projects.

• Gathers and manages data from electronic health records, specialized software, and outside sources related to HCC/RAF and other quality incentive programs.

• Build daily Reports, for appointment coordinators, to identify targets that are not canceled, have not been disqualified by appointment coordinators, or excluded otherwise

• Using Microsoft Access to build queries, build reports and automate daily tasks that refresh data from multiple sources.

• Create and distribute provider report cards (includes HCC/Quality stats, and the prevalence of top conditions) to top IPA PCPs

• Compare HCC/RAF and quality programs electronic data sent to health plans against the data that was received/accepted by the health plans

• Works data leakage for HCC Drop off; identifies HCCs for members that have not been captured/recaptured.

• Analyzes external health industry benchmark data to determine clients' comparative performance in clinical quality, cost efficiency, and patient experience.

• Builds relationships with internal/external stakeholders to promote HCC programs.

• Participates in meetings in support of HCC/Data Validation Objectives, as requested in order to establish and maintain interdepartmental and external partner communications and cooperation.

• Assists members of the Business Intelligence community and other departmental team members in accessing and analyzing health care data and information.

REQUIRED KNOWLEDGE & SKILLS:

• Expert knowledge of Microsoft Access databases and SQL language.

• Efficient in maintaining and enhancing databases in order to provide timely/accurate data to all other incentive program users.

• Create and deliver finished HCC/RAF and quality incentive program reports to individuals from a wide variety of functional and seniority levels.

• Comprehensive understanding of multiple HCC/RAF and quality measures related sources of data such as electronic health records, HCC/RAF and quality programs software, outside data sources, etc.

• Working knowledge of database applications, including extraction and querying skills.

• Focused use of data and information, including quantitative and predictive analytics to drive business decisions in a transformational health care environment.

• Organized with effective time and project management skills.

• Technically proficient in the use of data analysis and reporting systems and software used for information and analysis.

EDUCATION & EXPERIENCE:

• Bachelors in Business Administration in science, social science, public health, health services research or equivalency of a combination of education and directly related experience within a medical area

• CPC Certification is a Plus.

• 3 years of experience analyzing and manipulating Healthcare data, including general knowledge of understanding clinical coding systems (e.g., ICD- 10, CPT, DRG, REV codes)

• Thorough knowledge of Medicare Risk Model and CMS guidelines, Encounter data submissions, Risk adjustment processing, and data validations (RADV) preferred. Proficient using MS Excel applies to the application of data extraction in various reporting requirements; must have experience in data manipulation using database and spreadsheet applications