This position is responsible for collaborating with clients, operational leads and subject matter experts to develop and implement tactics and strategy for optimizing profitability, clinical performance, member and provider satisfaction and client satisfaction by developing and leveraging analytic tools, financial models and reports, marketing and outreach. In addition to being an expert SAS, Tableau and Excel developer, each Lead Healthcare Analyst is responsible for maintaining close collaborative relationships with one or more DentaQuest Regional Vice Presidents and all client and provider directors and managers within the states in the assigned region, and for presenting recommendations, strategies and findings. The Lead Healthcare Analyst will organize, lead and support efforts to measure, analyze and report on trends enterprise-wide related to provider utilization, reimbursements, access to care, cost management, etc. and identify and promote strategies to positively influence access to quality, cost effective care and improved program performance. This individual will also work with other areas of the company, including Underwriting, Provider Services, Clinical Management and Client Services to assist in the understanding of provider cost and network trends impacting program costs and profitability and to recommend strategies for improvement wherever possible.
PRIMARY JOB RESPONSIBILITIES:
Lead point of contact for a DentaQuest business region.
Responsible for tactical and strategic partnership with a Regional Vice President in identifying, interpreting, prioritizing, designing and procuring analyses guide business decisions.
Responsible for partnering with business and clinical teams and other internal clients and resources to enable and execute impactful, accurate business analytics.
Lead analytic projects and coordinate teams of analysts and programmers to deliver on internal client needs.
Develop, maintain and enforce compliance with project and campaign plans.
Use SAS, Python, R and other tools to analyze complex business challenges and help to define best practices for:
Benefit structures and algorithms
System edits, fraud detection, UM and UR
Member behavior management
Present technical findings and methodologies and present recommendations to senior clients in written and visual presentations.
Provide mentoring and support to analysts to assist in their development and ability to meet department needs.
Monitor and track provider reimbursements to identify strategies to ensure access and profitability targets are met in a manner that is consistent with quality, cost effective care.
Work with other internal departments as necessary to develop strategies and programs to manage dental costs within each market to assure profitability and budgetary goals are met.
Provide recommendations on department policies, objectives and initiatives. Evaluate and suggest changes as necessary to optimize processes and efficiencies.
Participate in special projects as needed or requested.
Adhere to DentaQuest and Business Analytics business processes, SOPs and quality control standards.
Advanced experience with database and business intelligence tools such as SAS, Python, R, Tableau, Cognos, MS Report Manager and Report Builder.
Experience designing and implementing complex algorithms and/or quality metrics.
Knowledge of health care industry is preferred.
Strong foundation in statistical theory and practice required.
Demonstrated ability to analyze and solve complex problems.
Excellent PC skills with proficiency in Excel essential.
Strong customer service and analytical skills.
Strong time management and business process skills.
Ability work well with others.
Ability to meet multiple deadlines in a fast-paced environment.
Ability to work in a traditional professional office setting or remote equivalent.
Ability to effectively operate computer equipment.
Work schedule may vary and is determined by project schedules.
Ability to travel as projects dictate.
Ability to efficiently operate all job-related office equipment.
Ability to communicate via telephone and work in virtual teams.
Ability to work in a dynamic environment.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria necessary to successfully perform this position.
In accordance with DentaQuest's Compliance Plan, employee must conduct DQ business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or DQ's Compliance Officer.
DentaQuest's Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please see Human Resources for additional information regarding this Program.