Data Measurement & Reporting Advisor (Provider Network) - Hybrid

Summary

Supports the medical cost position of assigned markets through analysis of healthcare provider contracts, analysis of high performing network solutions, analysis of medical expense reports, data drill downs of trend drivers, and execution of key initiatives designed to address medical expense and product pricing trends.

Partners with network management and pricing units to deliver medical expense results in line with trend/cost expectations to ensure strong competitive positioning within the marketplace.

Responsibilities


* Provide analytical and strategic support of health care provider rate negotiations


* Identify opportunities for medical cost reduction, lead action plan development, and drive execution


* Assess the cost and quality efficiency of health care providers


* Collaborate with network team to develop and maintain high performing network solutions


* Assess competitiveness of standard and high performing network products


* Analyze reports and present findings to business partners at various levels of the organization


* Support business partners and team members on an ad hoc basis as needed to support various integral business needs


* Maintain strong communication with other analysts to identify new opportunities and share best practices


* Mentor/train direct report, other analysts and business partners


* Own tracking tool maintenance and institute data validation processes


* Collaborate with developers on tool enhancements

Qualifications


* 5+ years' of experience with health care data analysis, medical cost trend analysis and health care provider contract analysis


* Understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, and utilization management


* Knowledge of standard medical coding including CPT-IV, ICD-10, DRG, revenue codes, and HCPCS


* Technical sophistication with various data mining and business intelligence tools such as SAS and/or SQL and advanced Microsoft Excel skills


* Strong analytical and problem-solving skills with a proven track record of success


* Prior Management experience is preferred as there is an expectation of having one direct report accounting for a portion of your time/duties


* Ability to independently perform data analysis while managing multiple projects and meeting strict deadlines


* Strong ability to validate and interpret results


* Ability to influence and drive strategic planning and execution through engagement of business partners, education on key drivers and actionable levers, and thorough understanding of market-level dynamics


* Strong communication skills to include written, oral, and group presentation

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps downloa...