- Lead partnership with internal departments, such as Finance, Actuarial and Provider Network, as well as Analytics leadership related to Value Based Payment strategy development and execution.
- Perform accurate and complete data extraction from data warehouse as well as nonstandard data sources to meet project requirements. This would include cleaning, transformation and pre-processing data using software programs such as t-SQL, SAS, etc.
- Develop solutions that visualize data and allow customer to interact with the data using data visualization software solutions such as Tableau or Microsoft Power BI.
- Develop reports and analysis to support RFP process, large employer, as well as various state and federal requests.
- Develop VBP solutions that calculate and analyze value based payment terms including development of reports, running of monthly report processes as well as reporting to support financial reconciliation processes.
- Development and maintain expertise related to value based payment approaches and provide consultation on new value based payment approaches in partnership with Actuarial department.
- Evaluate impact of business changes on risk reports specifications such as plan, benefit, network, provider configuration and payment and other operational changes.
- Review and interpret contract language related to risk contracting terms such as financial terms as well as quality or utilization metrics as part of the requirements gathering process.
- Facilitate and provide collection of feedback on proposed contract language to ensure that contract language is administrable and meets intent of value based payment arrangement.
- Prepare ad hoc analysis related to cost and utilization opportunities related to value based payment arrangements.
- Lead team's ongoing development of error checks, unit test and validation processes.
- Collaborate with Analytics leadership in the development of training and development strategies. Provide mentorship to team members including input on team learning objectives.
- Help identify and lead process improvement efforts.
- Develop and maintain documentation and training materials including job aids.
- Present complex data, analysis and findings to teams in a way that is clear and understandable.
- Provide information and support for ad hoc analytic projects for internal customers.
- Respond to ad-hoc analytic requests.
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
- Building Customer Loyalty
- Building Strategic Work Relationships
- Contributing to Team Success
- Planning and Organizing
- Continuous Improvement
- Adaptability
- Building Trust
- Work Standards
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
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Senior Value Based Payment Data Analyst - Bend, United States - PacificSource
Description
Looking for a way to make an impact and help people?
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Position Overview:
Position Overview: Primary subject of analytic support related to value based payments, financial modeling for provider contracting, support of large employer RFP, large employer reporting and analysis and state or federally mandated reporting and analysis. Analytical role may vary and involve knowledge of value based payments, provider contract language, healthcare utilization, healthcare benefits and state and federal guidelines. Some roles serve as a trusted Analytics partner regarding aspects of the provider settlement process for a variety of value based payment arrangements; coordinates with multiple departments and validates data used in the settlement and payment processes; produces contractually required monthly reporting and settlements in a timely, accurate and easy to understand format for external provider audiences; provides financial guidance and support; supports cost savings and process improvement efforts; provides financial governance and oversight.
Essential Responsibilities:
Supporting Responsibilities:
SUCCESS PROFILE
Work Experience: Five years' experience in health insurance or related field. Proven ability to manage multiple projects and competing deadlines. Ability to manage workload within a team environment or without direct supervision. Ability to effectively work with a broad range of stakeholders, including the ability to influence where applicable. Ability to develop, document and adhere to department policies and procedures. Ability to conceptualize solutions to complex problems; readily anticipates problems and identifies solutions. Articulates complex and/or complicated issues with a high level of skill, including listening and influence. Demonstrated team mentorship experience. Analytics experience related to value based payment.
Education, Certificates, Licenses: Bachelor's degree in Mathematics, Computer Science, Statistics, Engineering, Economics, Public Health or similar research related field.
Knowledge: General knowledge of business principles, theories and concepts. Ability to deal responsibly with confidential information. Proficiency in at least one statistical/analytical programming tools such as R, SAS, SPSS. Proficiency in other technical applications such as Tableau, SQL, and web-based database tools. Skilled in Microsoft Office: Word, Excel, PowerPoint and Outlook.
Preferred Knowledge: Familiarity with Medicare Five-Star, Oregon Quality Incentive Measures and/or NCQA HEDIS. Knowledge of health plan operations, data sources, and data structures.
Competencies
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.
Skills:
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
Physical Requirements:Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer:This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
