Population Health BA

Description

Consultant Technical Analyst - Population Health and Care Management

Job Summary

• Must demonstrate strong domain expertise, particularly in the

Payor-Provider ecosystem, with a solid understanding of Medicare,

Medicaid, and other relevant healthcare programs

future data needs

a normalized data model.

domains such as Care Management, Utilization Management, Quality

Scores, HEDIS, Care gaps

and explain business and technical issues and to provide viable

technology solutions.

Responsibilities

○ Act as a quality consultant and subject matter expert, performing

testing and validation of the mapping of data elements to standards

○ Collaborates with technical resources to perform root cause analysis

and complete remediation of data quality issues

○ Works with customers to clarify and plan for their current and future

technology needs. Determines and maps existing business

Processes / functions And Recommends Changes Required To Fit a Tightly

integrated system.

○ Designs and implements projects requiring systems integration, small

teams and multiple technical platforms.

○ Conducts Return on Investment (ROI) and other financial analysis to

support project funding / prioritization.

○ Collaborates on driving improvement activities to achieve department

and organizational goals.

○ Coordinates with functional team to assure consistency and

optimization of overall work product

○ Assumes a proactive role in driving improvement activities to achieve

department and organizational goals to deliver value.

○ Maintains current knowledge of industry and business process trends

and is able to apply that knowledge to existing business processes.

○ Provides subject-matter expertise of Health Ministry processes, policies

and requirements in support of functional area process design, testing

and implementation

○ Identifies opportunities for process improvement and makes

recommendations that lead to improvements

○ Monitors task assignments to ensure they are performed on schedule,

within intended scope and to a defined level of quality.

○ Escalates process and project issues that cannot be resolved

Experience

○ Prior experience working as a Population Health analyst in the

Healthcare system.

○ Must have a working knowledge of relational databases / database

structures, SQL expertise desired

○ Must have a strong understanding of data collected and used in

Claims, Adjudications, Health Insurance and Care and Utilization

Management

○ Knowledge and experience with ambulatory and acute clinical, billing

and claims workflows and clinical information systems.

○ Bachelor or Masters degree in related health or finance field ex

informatics or bioinformatics.

○ Complexity of work : Within the scope of job, requires critical thinking

skills, decisive judgment and the ability to work with minimal

supervision. Must be able to work in a stressful environment.

Skills Required

clinical information systems, population health , hedis, Relational Databases, utilization management, Health Insurance, Sql