Note: The job is a remote job and is open to candidates in USA. Highmark Inc. is seeking a Senior Provider Analytics Consultant focused on critical data management and regulatory compliance. The role involves data manipulation, analysis, and the development of reports and tools to enhance operational efficiency within provider functions.
Responsibilities
- Develops complex and innovative internal and external facing provider reports/analytic tools that clearly highlight key performance indicators for value based reimbursement programs and examine the major trend drivers of overall financial/quality performance; engineers reports to have self-service capability enabling customers to use the report and tools independently. Drives collaboration across several analytic groups to ensure reporting is comprehensive and accurate
- Proactively designs complex scorecards and dashboards using advanced analytic tools to support value based reimbursement arrangements with large strategic partners in the market. Demonstrates expertise in how strategic partners use the reports and identifies opportunities to improve existing reports. Engages with key strategic partners to foster an understanding of reports, anticipate needs, and drive strategy around reporting/analytic tools
- Supports the creation of the most impactful and broadest value based reimbursement programs across the enterprise, including initiatives for PCPs, specialists, facilities, post-acute providers, and ancillary providers. Proactively anticipates technical hurdles and leverages experience to drive positive outcomes. Consistently shares insights with lesser experienced staff members to help influence the best possible decisions
- Interprets raw claims, provider, quality, and member data to build data sets for analytic and reporting purposes. Displays mastery of multiple programming and query tools and is a resource to less experienced teammates. Dedicates time to research and implement process improvement/automation of existing reports. Communicates best practices across the department
- Leads provider cost savings analyses related to value based reimbursement and understands how return on investment impacts the enterprise and the provider. Generates ideas for potential cost-saving initiatives by utilizing experience of market dynamics and what has historically delivered outcomes and effectively communicates these concepts to stakeholders
- Reports on financial outcomes of value based provider arrangements and provider incentives to accurately reflect financial position. Routinely identifies potential risks and opportunities and clearly defines scenarios for achieving certain outcomes
- Enhances department influence by providing responsive service and expert consultation. Effectively and confidently presents information and provides decision support to team members and senior management. Ensures highly visible and effective communication channels are implemented to monitor sentiment, feedback, and acceptance of change. Anticipates a customer's needs and responds appropriately
Skills
- CANDIDATE MUST BE US Citizen (due to contractual/access requirements)
- 10 years of Relevant analytic work experience
- Bachelors degree in Mathematics, Statistics, Finance & Accounting, Actuarial Science, Economics or related field or 6 years of relevant work experience in lieu of a Bachelor's Degree
- None
- 10 years Insurance or healthcare work experience
- Master's degree in a technical field (e.g., Computer Science, Data Science, Information Systems), Health Informatics, or a related field
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