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SalaryCompany Description:
Umpqua Health stands at the forefront of community health as a leading Coordinated Care Organization (CCO) committed to transforming healthcare delivery. Our mission is to enhance the well-being and health of the communities we serve through innovative, integrated, and patient-centered care. As a CCO, we are dedicated to coordinating physical, mental, and dental health services, ensuring comprehensive care for our members. Our team comprises professionals who are passionate about making a difference in healthcare. We value diversity, inclusivity, and the unique perspectives of our team members, creating a collaborative and supportive work environment. This synergy is essential in our approach to delivering holistic and personalized care to our community.
At Umpqua Health, safety and well-being are paramount. We maintain a drug-free workplace policy to ensure a healthy and productive environment for our employees, patients, and the community at large. This policy includes drug screening for all potential hires and a strict no-drug policy across our organization.
As a member of the Decision Support Team, you will have the opportunity to provide oversight and apply your analytical and problem solving skills gathering and summarizing statistical data into meaningful and actionable reports. Utilizing a variety of software platforms, the Decision Support Team assists in the preparation and development of robust reporting for the Umpqua Health leadership team, managers and other organizational stakeholders. Under management directive, this individual may evaluate reports and make recommendations which impact business decisions. Position will support the Senior Director of Decision Support, Director of Customer Care and the Manager of Utilization Program.
Your Impact:
- Run queries and create analysis utilizing all data warehouse systems.
- Provide ad hoc utilization and operational reporting to various departments.
- Primarily focuses on constructing standard dashboards and reporting, and assists in special projects as required.
- Perform complex financial analysis related to special projects.
- Perform routine and ad hoc audits of health plan claims data warehouse.
- Provide analytical reports for various departments and workgroups as requested.
- Maintain and update databases and reports used as reference for internal staff.
- Respond and resolve data inquiries on select subject matters in a timely manner.
- Compile, organize and analyze data from various sources to serve as research initiatives and to validate Enrollment, Encounter Data and Prior Authorization Utilization.
- Develop and provide complex reporting and analysis on health plan data.
- Track population and health trends for purposes of identifying target areas of utilization and case management.
- Assist data extracts and validation for the purposes of state mandated reporting requirements.
- Document processes for preparing any monthly or routine reporting.
- Create tools, spreadsheets and systems to improve prior authorization data analysis and reporting.
- Response to any Encounter Data OHA memos requesting validation of anomalies/discrepancies at an aggregate level.
- Identify and correct any Enrollment errors, including potential/missed Enrollments.
- Understand benefit plan coverage, enrollment, claims processing and policies and be able to concisely communicate this information as necessary.
- Reviews and processes the monthly/weekly reporting (Case Management Incentive, Membership by Tier, Open-Closed, Newborn, etc.).
- Develops, documents and maintains policies and procedures in relation to data reconciliation, auditing and monitoring.
- Participates in state conference calls and monthly workgroups in relation to job duties.
- Assists in performing internal audits to ensure processes and procedures are being performed properly.
- Proven strong project management, multi-tasking and presentation skills.
- Maintains high level understanding of Medicare and Oregon Health Plan benefits packages.
- Comply with organization’s internal policies and procedures, Code of Conduct, Compliance Plan, along with applicable Federal, State, and local regulations.
Your Credentials:
- Bachelor’s degree or equivalent experience
- 1+ years of experience in healthcare data analytics or related field
- Proficient in Microsoft Office; expert in Excel.
- Minimum 1 year of Tableau or other data visualization software.
- Minimum 1 year of SQL experience.
- Experience with data modeling, ETL processes, and data warehousing concepts
- Knowledge of healthcare data standards and regulations (e.g., HIPAA, HITECH, etc.)
- Excellent verbal and written communication skills as well as, outstanding problem solving, organizational and leadership skills.
- Proven strong project management, multi-tasking and presentation skills.
- Demonstrated ability to successfully work with diverse teams.
- No suspension/exclusion/debarment from participation in federal health care programs (eg. Medicare/Medicaid)
- Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis.
- Experience working with different communication styles.
Umpqua Health is an equal-opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and business needs. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.
