Senior level position responsible for providing support to management in the Medical Policies Department for a broad range of initiatives related to the Medical Policies. Performs complex data analysis to provide leadership with actionable, qualitative and quantitative information as well as benchmarking and trending to drive effective business decisions . Working with marginal oversight, the incumbent is responsible for performing complex research, analysis and reporting of membership, utilization, cost and key operational information.
- We need candidates with strong experience with Medical Policies, Referrals, Pre Authorization.
- Claims and Adjudjication.
- RDS oversight. Assures that vendor producing RDS reports has access to internal EH data as needed.
- Develop, modify and maintain product reports and internal management reports. Prepare and maintain operational oversight reports and develop detailed analysis of findings. Perform appropriate analysis on data: forecasting, modeling etc.
- Develop and update internal databases and tracking systems.
- Responsible for participation in testing new software, software upgrades and data feeds according to vendor, regulatory and company protocols.
- Act as liaison with IT and vendors.
Skills & Knowledge:
- Possesses strong data analysis skills.
- Possesses advanced PC literacy.
- Ability to plan, organize and prioritize assignments and anticipate needs.
- Team Player.
- Detail oriented and creative problem solving ability.
- Bachelor’s degree or equivalent work experience.
- Minimum 4 - 6 years’ work experience as a data analyst in the healthcare industry.
- Prior programming/system experience preferred with knowledge of QCare systems, Cognos/Data.Warehouse, Strong Business Objects and SAS
- Proficiency in use of all Microsoft Office products.
- Advanced knowledge of Access and relational databases required.