Medicare Clinical Data Analyst

Amerihealth Caritas Health Plan Philadelphia , PA 19107

Posted 2 months ago


Works on projects in strategy development, industry trends, competitive analysis, and company positioning as it relates to enterprise programs and initiatives. Develops and maintains a thorough understanding of business processes. Analyzes data to develop cost benefit analysis of proposed programs through collection and data analysis. Develops and presents specific recommendations to Medicare Risk Adjustment & Performance and Medicare LTSS as a member of the Medicare Data Integrity Team.

Essential Functions include but not limited to:

  • Perform in-depth analysis of department and end-user needs, documentation of requirements, and translation of requirements into proper system specifications using their clinical analysis background.

  • Responsible for helping to ensure the quality, compliance and accuracy of information entered into electronic systems and produced reporting.

  • Perform clinical data integrity validation reviews on records in various data formats and systems including auditing data input.

  • Document and report clinical quality levels.

  • Help ensure clinical operations are in compliance with an organization's standards, as well as any applicable state and federal regulations.

  • Help to ensure goals are met for clinical quality of service and overall program effectiveness.

  • Works on projects in strategy development, industry trends, competitive analysis, and company positioning as it relates to enterprise programs and initiatives.

  • Address issues that arise for application areas with understanding of the organization's policies, procedures, quality standards, and business operations.

  • Analyzes data related to Medicare Clinical programs/services, assuring proper reporting to company management and regulatory partners.

  • Prepares correlation reports related to program results, and other measurements of success.

  • Develops and presents analyses of proposed programs and makes specific recommendations tied to the business goals of the department and the enterprise.

  • Assist in preparation for regulatory and internal audit submissions.

  • Develop and maintain ICM and LTSS based reports to support initiatives.

  • Represent Data Integrity in collaboration with internal departments for performance improvement.

  • Perform clinical data investigations as requested.

  • Able to assimilate into team within minimum amount of assistance.

  • Ability to work collaboratively with teams of all sizes.

  • Ability to multitask complex work assignments.

  • Exceptional oral and written communication skills.

  • Assures the ongoing high performance level of the overall department through continued knowledge acquisition and knowledge sharing with co-workers.

  • Maintains a current knowledge of CMS and DHHS requirements and updating job knowledge by engaging in educational opportunities and regular training.

  • Adheres to AmeriHealth Caritas policies and procedures.

  • Creates and supports an environment which fosters teamwork, cooperation, respect and diversity.

  • Instills work culture of continuous process improvement, innovation and quality.

  • Demonstrates and supports commitment to corporate goals and objectives.

  • Performs other related duties and projects as assigned.

Education/ Experience:

  • Bachelor's Degree Required with a concentration in health care administration data analytics or related field

  • Working knowledge of SQL database and tools , e.g. TOAD, SQL developer preferred.

  • Working knowledge of Microsoft Office Suite and Tableau.

  • Demonstrated ability to analyze data within limited time periods and recommend operational actions and/or alternatives based on analysis.

  • Ability to work independently to prioritize and handle multiple projects and tasks to completion with limited direction.

  • 1 to 3 yeras experience in Data Analytics.

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Medicare Clinical Data Analyst

Amerihealth Caritas Health Plan