Healthcare Data Analyst (Remote)

 

Sentara Health Plan is currently hiring a Healthcare Data Analyst!

This is a Full-Time position with day shift hours and great benefits!

Work Location:

Remote opportunities available in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming.

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Job Responsibilities

This role is part of the Network Support and Provider Operations team. This position will potentially support contract modeling scenarios needed during contract negotiations by using both complex data models and a contract modeling system. This position will analyze yields of scenarios and monitor the alignment of performance with contract terms and assist in developing rates and terms within the contract management system to meet company goals. This position will also support analysis pertaining to provider reimbursement, market intelligence, claim utilization, and unit cost budget evaluation, as well as supporting SHP provider network and operations, system administration, and strategic expansion initiatives. Requires the ability to interpret, understand, and model complex provider contract reimbursement terms.

Requires the ability to data mine, interpret, understand, and summarize payer data including (but not limited to) medical, behavioral health, and pharmacy claims, as well as clinical, financial, member, and provider information.

Requires the ability to data mine, interpret, understand, and summarize payer data including (but not limited to) medical, behavioral health, and pharmacy claims, as well as clinical, financial, member, and provider information. This position will also create summaries, reports, and dashboards using various methodologies in an effort to provide clear and concise information for stakeholder decision support. Requires excellent oral and written communication skills.

• Data mine and analyze insurance payer claims, as well as member and provider data from disparate sources using multiple criterion within the context of specified projects.
• Identify and analyze medical expense trends within inpatient, outpatient, professional, and pharmacy claims data/utilization.
• Assist cost of care stakeholders with health plan cost saving initiative ideation through data stewardship and adoption.

Job Requirements:

• Required- Bachelor's degree.
• Data Analysis - 3 years,
• Healthcare – 1 years
• SQL, Tableau, Excel
• Preferred: Experience in payer claims data

Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks, and more.

Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

For applicants within Washington State, the following hiring range will be applied: $73,819.20 to $ 87,447.36 annually.

Sentara Health Plans is the health insurance division of Sentara Healthcare doing business.

Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.

With more than 30 years’ experience in the insurance business and 20 years’ experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services – all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-13805

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Talroo – Health Plan

Talroo

Keywords: Medical expense, cost of care, Insurance company, Medical expense trend, SQL, Tableau, Excel, Power BI, Healthcare, Health Plan, in-patient, out-patient, pharmacy, professional claims, cost savings, medical cost savings, cost savings initiatives, ROI, Member utilization, Claims utilization. Care management data. Ad-hoc reporting, Authorizations, Claims, Providers, Benefits. Remote, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming.

The Healthcare Data Analyst provides data analysis support to the customer by assisting with the development of reports and/or dashboards to monitor program and operational performance. Promotes self-service analytics for customer adoption, understanding and use of data. Supports design of programmatic analyses and reporting capabilities in addition to business requirement definition for new analyses and performs ad-hoc analysis as directed. This position supports data quality and data stewardship functions to maintain data accuracy and identify new metrics. As a subject matter expert, the Healthcare Data Analyst uses analytic skills to offer data-driven conclusions and recommendations to business partners. As an integrated health system, Sentara delivers analytics across a wide variety of domains, including payer functions, ambulatory, acute & post-acute care and support functions. The subject matter expertise required will vary based on the specific opening, but include the following: Medical expense and trends Quality including HEDIS reporting, interventions, and STAR ratings Clinical gaps and adherence Network Management contracting and pay-for-performance/value-based measures State and Federal regulatory reporting Employer groups reporting and client ad-hoc reporting related to clinical and financial services Population health reporting & analysis Risk, member/patient stratification, member/patient segmentation, quality, provider scoring, and cost savings Ambulatory, acute & post-acute quality, clinical performance, and operations reporting & analysis Quality & performance benchmarking Research data & analytic support Works directly with internal customers and external provider partners. Knowledge of SQL and Tableau Excellent Oral and Written Communication Skills Problem Solving Consultative Engagement Skills

• Master's Level Degree
• Bachelor's Level Degree

• Statistics 1 year
• Population Management 1 year
• Financial Analysis 1 year
• Data Analysis 1 year

• Reading Comprehension
• Service Orientation
• Time Management
• Troubleshooting
• Writing
• Communication
• Complex Problem Solving
• Coordination
• Active Learning
• Critical Thinking
• Active Listening

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