Sr. Predictive Health Analyst

Caresource Dayton , OH 45401

Posted 1 week ago

Role and Responsibility:

  • Responsible for developing, implementing, managing and presenting in-depth reports, predictive analytics, and modeling analyses that meet the organizational information needs regarding product benefits, policy, MCR, and/or prior authorization

  • Identify trends, patterns and opportunities in benefit utilization using standard corporate, processes, tools, reports and databases

  • Conduct analyses to determine impact and effectiveness of product benefits

  • Leads requirements gathering from various internal business partners to understand specific product benefit analytical needs

  • Leads development of product benefit, policy, and/or prior authorization monitoring reports, dashboards, self-service BI tools across markets to determine consistency and effectiveness

  • Generate graphics that effectively describe, explore and summarize analyses for communication to appropriate parties

  • Incorporate critical thinking skills and judgment in the analysis process to determine best course of action for each inquiry/problem

  • Review reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques that will reveal intelligence for identification of any associative or causal relationships and provide management level summaries that explain key findings

  • Utilize descriptive and predictive statistical techniques to measure impact of various actions/studies, internal and external, develop sampling and hypothesis testing to help the organization determine outcomes, and forecast and predict future behaviors and events

  • Evaluate and make appropriate improvements to internal analysis processes ensuring that practices are in line with the overall goals of the organization

  • Assists with scoping, planning, and prioritizing predictive analytic projects and staff

  • Assists with the development and maintenance of statistical models that enhance clinical strategy, operational efficiency and consumer experience

  • Proactively research, gather, analyze, and cross examine pharmacy and medical claims; perform analytics on intake requests for all department - MCR development within team workflow

  • Collaborate daily with an interdisciplinary team to align policy, member benefits, prior authorization, utilization, claims configuration, and IT goals for selected initiatives.

  • Perform any other job related instructions, as requested

Requirements

Education / Experience:

  • Bachelor's Degree or equivalent years of relevant work experience is required

  • Master's Degree (e.g., public health, mathematics, statistics, experimental psychology, epidemiology, health economics, nursing) preferred

  • Minimum of five (5) years of experience either data analysis, qualitative data analysis, research, and/or analytic programming or equivalent experience obtained via advanced degree(s)

  • Health care delivery and/or payer experience required

Required Competencies / Knowledge /

Skills:
  • Advanced experience with statistical analyses, predictive analytics, and modeling techniques such as multivariate regression, logistic regression, forecasting and time series models preferred

  • Advanced SQL querying experience (i.e. Microsoft SQL Server, PL/SQL Developer, SAS EG/Proc SQL)

  • Proven application of data mining tools and concepts including structured and unstructured data preferred

  • Proven understanding of relational databases and experience with large data sets preferred

  • Analytical software experience (e.g. Excel, Access, R, SAS, SPSS, SQL, PowerBI, Python, Tableau, Qlikview) skills

  • Graphic development/presentation skills

  • Knowledge of inferential statistics

  • Working knowledge of descriptive statistical application and techniques

  • Critical listening, thinking skills, and verbal and written communication skills

  • Decision making/problem solving skills

  • Ability to work independently and within a team environment

  • Knowledge of managed care and health care data coding

  • Ability to lead analytic efforts

  • Knowledge of managed care preferred

  • Knowledge of health care coding including CPT-4, HCPCS, ICD-9, DRG, and Revenue Codes preferred

Licensure / Certification:

  • None

Working Conditions:

  • General office environment; may be required to sit/stand for long periods of time

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Sr. Predictive Health Analyst

Caresource