The Senior Data Analyst manages data processes, including collection, analysis, and reporting, which are essential for decision-making and strategy in a healthcare insurance company.
The role involves maintaining data accuracy and compliance while contributing to initiatives like network adequacy, risk adjustment, marketing analytics, and quality assessment.
Key Responsibilities:
- Provider Network Maintenance and Adequacy Analysis: Support initiatives to assess and improve network adequacy. This includes analyzing provider networks, ensuring compliance with regulatory requirements, and identifying areas for expansion or enhancement.
- Risk Adjustment: Oversee data preparations for risk adjustment strategies and processes. This involves analyzing risk scores, understanding the impact on revenue and cost, and coordinating with clinical and coding teams to ensure accurate risk capture.
- Marketing Analytics: Directly interact with the marketing executive and use analytics in market segmentation, campaign effectiveness analysis, customer behavior modeling, and ROI analysis of marketing activities.
- HEDIS Quality of Care and Service Assessment: Oversees the analysis of Healthcare Effectiveness Data and Information Set (HEDIS) metrics to assess and improve service quality and care delivery. Implement strategies to meet or exceed quality benchmarks.
- Product Lifecycle Analysis and Data Management: Lead the analytics and operations of data sources. Ensure data integrity, accuracy, and security, and implement analytics and predictive modeling techniques to derive actionable insights.
- Leadership and Development: Mentor colleagues and team members to foster a culture of continuous learning and professional development.
- Cross-Functional Collaboration and Communication: Work closely with IT, clinical, finance, and operations teams to align analytical efforts with business goals. Regularly present insights and recommendations to senior management and relevant stakeholders.
Required Skills and Qualifications:
- Bachelor's or Master’s degree in Computer Science, Information Technology, Mathematics, Engineering, Statistics, Economics, Health Informatics, or related field.
- Minimum of 5 years of experience in analytics, preferably in the healthcare insurance industry.
- Proficiency in statistical and data analysis tools (e.g., Excel, R, Python).
- Experience delivering end-to-end analytics projects.
- Excellent in communicating and presenting, able to turn complex data into insights.
- Versatile in data stewardship, quality improvement, and training peers and colleagues.
- Competent in managing data lifecycle, creating reports, and data analysis with BI tools.
- Proficient in marketing analytics, particularly in digital marketing.
Candidates with the following knowledge is preferred:
- Healthcare data standards, taxonomies and reference data coding systems (i.e., ICD10, CPT, HCPCS, HCC, etc.).
- Healthcare integration technologies and techniques (i.e., HL7 v2 or higher, FHIR, EDI, etc.).
- CMS Risk Adjustment and Scoring methodologies.
- Familiarity with Looker analytics platform.
- Healthcare tools to measure the quality and service of care delivery (e.g., HEDIS).
- Survey methodologies, including strategies to improve reliability, validity, and usefulness.
- Data stewardship, regulatory requirements and industry best practices;
- Specific data handling requirements for patient identifiable information and protected health information.
