Associate Provider Data Analyst

at  Highmark Health

CANDIDATE MUST BE US CITIZEN (DUE TO CONTRACTUAL/ACCESS REQUIREMENTS)

The incumbent works closely with internal customers responsible for the design and operations of enterprise value based reimbursement programs. Has an understanding of key provider reimbursement concepts and the ability to communicate those concepts effectively. Delivers analytics and insights to key decision-makers to help guide and design programs and initiatives. Performs data modeling and partners with data management staff to work efficiently and capitalize on data automation opportunities. Reports on value based reimbursement program outcomes, trends, and drivers to improve financial performance.

SKILLS

• Analytic Judgement
• Effective Use of Technology
• Efficient and Organized Work Habits
• Strong Work Ethic & Standards

POSITION TYPE

Office- or Remote-based
Teaches / trains others
Occasionally
Travel from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

• Develops internal-facing provider reports/analytic tools to highlight key performance indicators for value based reimbursement programs and trend drivers of overall financial/quality performance.
• Designs basic scorecards and dashboards using analytic tools to support value based reimbursement arrangements with large strategic partners in the market.
• Supports the creation of value based reimbursement programs across the enterprise including initiatives for PCPs, specialists, facilities, post-acute providers, and ancillary providers.
• Interprets raw claims, provider, quality, and member data to build data sets to be used for analytic and reporting purposes.
• Assists with provider cost savings analyses related to value based reimbursement and understands how return on investment impacts the enterprise and the provider.
• Reports on financial outcomes of value based provider arrangements and provider incentives to accurately reflect the financial position.
• Interacts with stakeholders in a manner that fosters cooperation and teamwork while conveying engagement and competence. Provides responsive service and understands customer needs.
• Other duties as assigned or requested