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.
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.
Amerihealth Caritas Health Plan