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SalaryWHO WE ARE:
With the Health Division, you’ll be joining a passionate team of self-motivated change agents united by our mission: driving to design the delivery of high-quality healthcare for nearly three-quarters of a million active and retired Texas public educators.
The healthcare industry is complex and we’re a team of problem-solvers who are up for the challenge. With a focus on innovation and collaboration to catalyze the market, we spend nearly $4 billion annually on healthcare to make a difference in our members’ lives. With a career at TRS, you’ll be empowered through a culture of continuous learning, front-line decision-making, coaching and mentorship to shape the future of our work, while transforming healthcare delivery for 1 in 41 Texans.
The Health Data Analyst or Associate performs complex data analysis and research on health care claims data and participates in contract administration and vendor procurement activities as a member of the Finance Team in the TRS Health division. Work in a small, highly productive team to develop data queries and analyze and/or model health care data to assess the health plan performance and healthcare trends; oversee the work of vendors supporting the health plans; and support the procurement and contracting of health care and related services. This position will proactively work with Health division staff, agency employees, and health care vendors.
This vacancy will be filled at one of two levels - Health Data Analyst Associate or Health Data Analyst. Selected candidate will be offered the position that most closely matches their education and experience.
This hybrid position will require the selected applicant to report to the TRS offices, located in Austin, TX, 1-2 times per month or as needed to meet business needs. Selected candidate must reside in Texas throughout employment with TRS.
Salary range:
Health Data Analyst Associate: $59,155 -$73,943 annually
Health Data Analyst: $70,276 - $87,845 annually
WHAT YOU WILL DO:
Research and Data Analysis
- Develops and automates queries in TRS’ data warehouse to extract data for use in spreadsheets, models, dashboards, and summaries that support decision-making.
- Reviews and reports on health care claims, participant service utilization, and pricing to assist with Health management decisions.
- Facilitates the interpretation of health care data from external sources including data from TRS' health care consultants, insurance companies, or other industry resources.
- Analyzes detailed enrollment, claim, utilization and other health care related data to identify trends and anomalies, and to identify areas of action.
- Reviews and validates reports on health plan performance.
- Analyzes provider reimbursement levels, high cost claims, costs by geographic area and place of service, and claim accuracy. (Analyst)
- Identifies enrollment and cost trends, cost-saving opportunities, and potential fraud, waste, and abuse. (Analyst)
Health Care Services Procurement & Contract Management
- Escalates service issues with vendors internally to the Contract Manager.
- Works with vendors and external partners to carry out research related to the administration of TRS health plans. (Analyst)
- Communicates regularly with vendors to address business needs and service issues. (Analyst)
- Reviews and analyzes various routine vendor reports on a monthly, quarterly, and annual basis.
- Assists the Contract Manager and TRS' legal and purchasing departments in the renewal of contracts and amendments.
- Assists with evaluating Health's business needs related to plan performance and vendor services.
- Assists with the evaluation of bidder proposals with respect to operational capabilities and financial terms. (Analyst)
- Assists with the development of procurement documents, such as statements of work and evaluation criteria.
Health Plan Administration
- May communicate with vendors related to plan performance, initiatives, claims and utilization, provider network updates, pharmaceutical changes, marketplace situations and trends.
- Assists with the reconciliation of financial performance guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs.
- Supports other areas of Health in analyzing program data and developing key performance indicators and dashboards as needed.
- Assists the Contract Manager in monitoring vendor performance in areas of cost trends, service/process quality and delivery, implementation of plan initiatives, and contract compliance.
- Reviews claim and enrollment data to provide support for invoice processing and benefit decision-making.
- Participates on special projects, task forces, and committees as needed.
- Performs related work as assigned.
Required Education
- Bachelor's degree from an accredited college or university in health information management, health care administration, public health, statistics, finance, business or a closely related field.
- High school diploma or equivalent and additional full-time experience in health plan administration, Health Data and/or health financial analysis, claim auditing or similarly related experience may be substituted on an equivalent year-for-year basis.
Required Experience
- One year of full-time directly related, progressively responsible experience in analyzing health care claims data, health financial data, administration of a health insurance plan or similarly related experience.
- Three (3) years of full-time directly related, progressively responsible experience in analyzing health care claims data, health financial data, administration of a health insurance plan or similarly related experience. (Analyst)
- A master's degree or doctoral degree in a directly related field may be substituted on an equivalent year-for-year basis.
Preferred Qualifications
- Advanced degree in actuary science, finance, mathematics, statistics, business, health care administrations, or closely related field.
- Recent experience in health plan administration or consulting, pharmacy benefits, actuarial services, business finance, claim auditing, procurement and contracting.
Knowledge of
- Data analysis concepts and methods, including education equivalent to at least statistics for business, health benefit claims processing, Medicare, coordination of benefits, standard medical procedures, and billing.
- Health care claims data including CPT, HCPCS, DRG, ICD-10, and NDC.
- Health care related laws, regulations, policies and procedures.
- Self-funded and fully insured group health benefit products and contracts, including Medicare Advantage.
- Provider networks, contracts, plan operations and systems.
- Healthcare systems and clinical concepts.
Skill in
- Writing programming code to process data including SQL and other tools such as R or Python.
- Researching, compiling and analyzing complex data, including querying a claim data warehouse.
- Managing projects, including planning, organizing, and prioritizing work assignments to manage a high-volume workload in a fast-paced and changing environment.
- Interpreting and applying complex laws, regulations, policies, and procedures.
- Completing detailed work with a high degree of accuracy.
- Meet frequent and multiple deadlines, manage conflicting priorities and demands, and adapt to changes in schedules and assignments.
- Think critically, analyze problems, evaluate alternatives, and recommend effective solutions.
- Communicate effectively and maintain harmonious working relationships with co-workers, agency staff, vendors and other external contacts and to work collaboratively in a professional team environment.
Military Occupational Specialty (MOS) Codes:
Veterans, Reservists or Guardsmen with experience in the Military Occupational Specialty ( http://www.hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_AdministrativeSupport.pdf ) along with the minimum qualifications listed above may meet the minimum requirements and are highly encouraged to apply. Please contact Talent Acquisition at careers@trs.texas.gov with questions or for additional information.
To view all job vacancies, visit www.trs.texas.gov/careers or www.trs.csod.com/careersite.
For more information, visit www.trs.texas.gov.
