Senior Health Plan Operations Analyst
About this Job: General Summary of Position Defines develops and prepares reports dashboards and analysis to support organization's goal of providing executive leadership with actionable intelligence related to the financial clinical and analytical performance. Provides specialized analytics and data driven insights to assist in developing recommendations for process improvement identifying trends and identifying root cause analysis. Collaborates with various areas to operationalize process improvements and mitigates/resolves negative trends in operational and clinical data.This position requires a thorough understanding of departmental and clinical operations data modeling and programmatic methodologies. Primary Duties and Responsibilities Performs advanced analytics of various aspects of operations monitors trends and reports findings. Collects and utilizes operational and benchmarking data to recommend targets for improvements in customer service productivity and control of costs. Support ad-hoc reporting and analysis for operational and clinical business units. Performs root cause analysis to understand performance of programs and identifies opportunities for improvement. Prepares appropriate reports and statistics and conducts surveys in order to evaluate departmental operational and fiscal performance. Develops financial reporting and analytics to measure ROI and support cross-functional initiatives Leads development and production of reporting for cost revenue and utilization improvements. Teaches and mentors junior staff to develop their technical and analytical critical thinking skills Assists the plan leadership and all managers in the analysis of health plan operations for the preparation of operational and financial recommendations to the plan leadership. Coaches and assist other managers with their development. Develops standards of performance evaluate performance and conduct performance management planning. Develops and maintains dashboard reports using MS SQL MS Excel Power BI and Tableau to visualize data and provide insight applying accurate and appropriate interpretation of data. Builds SSRS and SSIS reports maintains existing reports and creates new reports. Participates in meetings and on committees as assigned. Participates in multi-disciplinary quality and service improvement teams. Minimal Qualifications Education Bachelor's degree in Healthcare Administration Finance Information Technology Business Adminsitration or related field required Experience 5-7 years Experience in managed care or healthcare accounting finance analytics project leadership or related experience. required 5-7 years Experience in relational database management and analysis experience in Excel ODBC SQL SSRS and SISS reporting Tableau reporting and care management systems required Licenses and Certifications Certified Tableau Specialist Tableau certification preferred SQL certification preferred Knowledge Skills and Abilities An in-depth understanding of national reimbursement mechanisms (CMS-1500 UB forms ICD-10 PPS CPT HCPCS) as well as local regulatory environment. Strong understanding of operational activities around claims enrollment call center utilization management etc. related data. Extensive database experience (SQL coding experience preferred) with ability to access and manipulate significant amounts of complex data to produce meaningful and useful reports for senior management. Experience in advanced statistical models business intelligence tools risk adjustment methodologies and data visualization software strongly preferred. Tableau experience is preferred but not required. Ability to convey verbal and written information effectively. Ability to follow verbal and written instructions. Verbal and written communication skills. Computer skills preferred. This position has a hiring range of : USD $71,843.00 - USD $135,907.00 /Yr.