JOB SUMMARY

Provide advanced analytic data support for the Quality Management Department teams for quality management outcomes, contractual compliance, and key business objectives. Create and maintain databases to track performance. Manage complex data projects. Profiles data to identify opportunities for use and improvement in data quality. Complete ad hoc analysis requests as needed. Primary focus on HEDIS and Population Health teams with all aspects of related member and provider, claims, lab and pharmacy data. Build and run and SQL queries for data integrations. Run complex ETL processes for claim data. Develop ETL processes to integrate with 3rd party vendors. Document key steps, assumptions, and dependencies. Perform data analyses, including contributing to prototype building of new analytic solutions as well as ad hoc analyses. MS SQL Database T-SQL development/stored procedures with performance tuning with system tables knowledge for any DB health monitoring. Manage the entire data repository process including documenting SOPs for data retrieved, received, transmitted, transformed/mapped and implement best practice approach to ensure data integrity. Create data dictionaries and layouts to conform with use-case needs.

EXPERIENCE

• 4 – 6 years of relevant professional work experience, required.
• Business Intelligence experience in the health insurance industry, and/or managed-care environment, required.
• Experience working with healthcare/payer data and experience, experience managing large amounts of data and proficiency using data access tools, required.

SKILLS/COMPETENCIES

• High level of proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook) required.
• Expertise with SQL required.
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences required.
• Knowledge of clinical coding terminology.
• Knowledge of current healthcare data transmission and file types.
• High level of attention to detail.
• Ability to work both independently and as a team member. Able to meet strict deadlines.
• Able to identify and solve problems that may arise during a project. Adaptable and able to adjust plans/strategies to keep project on track to completion. Analytical mindset with excellent organizational and problem-solving skills. Aware of areas of non-compliance and able to recommend process improvement initiatives.
• Manages assigned workload in accordance with established performance metrics.

EDUCATION/CERTIFICATION/LICENCE

• Bachelor’s Degree in Mathematics, Economics, Statistics, IT, Computer Science or a related field, required.
• Certification/portfolio in Business Intelligence, preferred.

BENEFITS SUMMARY:

SVCMC, Inc. provides a robust benefits package that includes medical coverage through UnitedHealthcare/Oxford with no deductible for in-network services. Employees also receive vision coverage through UnitedHealthcare Vision and dental benefits through MetLife. Basic life and disability insurance are automatically provided at no cost. All employees are eligible for commuter benefits, tuition reimbursement, and a 401(k)-retirement plan with an immediate employer match that is fully vested from day one. SVCMC also offers a generous time off package, which includes vacation, 10 paid holidays, and 3 personal days. Additionally, employees have access to a comprehensive Employee Assistance Program and exclusive discounts through Working Advantage.

SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER – ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO VETERAN STATUS, DISABILITY, OR OTHER CHARACTERISTICS PROTECTED BY LAW.

Job Type: Full-time
Pay: $115,000.00 - $120,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Family leave
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance
• Work from home

Education:

• Bachelor’s (Required)

Experience:

• HEDIS report writing: 4 years (Required)
• SQL: 5 years (Required)

Work Location: Remot

• Provide data analytical support to all teams in the Quality Department as assigned or required .
• Manage complex data projects.
• Produce, publish and distribute scheduled and ad hoc reports .
• Work on iterative enhancements of analytics assets over time.
• Address ad hoc analysis needs as they arise.
• Ability and inclination to adopt technology to maximize efficiency.
• Perform other duties as assigned or required.
• Aware of the potential for fraud and waste and how to report suspected fraudulent activity.

HEDIS and Population Health

• Follow design requirements/guidance from HEDIS and Population Team Senior Director/Manager and build out data integrations and perform data analysis based on business needs/requests.
• Following blueprint designs from Senior Director/Manager, quickly create prototypes for enterprise-level analytic solutions, utilizing multiple data sources.
• Extract, load, model, and reconcile large amounts of data across multiple system platforms and sources.
• Conduct data validation across all phases of work performed.
• Review data to determine operational impacts and needed actions; elevate to management issues, trends, areas for improvement and opportunities. Develop reports and deliverables. Evaluate data for trends.
• Ensure compliance with applicable TRICARE data reporting and security requirements.
• Iteratively build up complex ETL processes; check the accuracy of the steps o Conduct data validation with medical record review to ensure accuracy of EMR data extractions.
• Make suggestions on data manipulations that best serve the business requirements.
• Handle any data imperfections pragmatically.
• Document the ETL process timely and adequately.