Health Data Analyst - Remote

Requisition ID: req887 Employment Type: Unclassified Regular Full-Time (URF) Division: HIB Finance Compensation: Depends on Qualifications Location: TRS Job Closing: 8/11/2023 5:00pm

WHO WE ARE:
With the Health & Insurance Benefits 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.

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The Health Data Analyst performs complex data analysis and research on health care claims data and participates in contract administration and vendor procurement activities. Work involves developing data queries and analyzing health care data to assess the health plan performance; overseeing the work of vendors supporting the health plans; and supporting the procurement and contracting of health care and related services. Works under limited supervision with considerable latitude for initiative and independent judgement. This position will proactively work with HIB staff, agency employees, and health care vendors.

This a primarily remote position that will require the selected applicant to report to the TRS offices, located in Austin, TX, 1-2 times per quarter or as needed to meet business needs.

All applicants must reside in the state of Texas upon employment and continue to reside in Texas throughout employment with TRS.

This vacancy will be filled at one of two levels - Health Data Analyst or Senior Health Data Analyst. Selected applicant will be offered the position that most closely matches their education and experience.
Salary Range
Health Data Analyst: $66,930 - $83,662 
Senior Health Data Analyst: $80,985 - $101,231
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.
Reconciles financial performance guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs. (Senior)
Reviews and reports on health care claims, participant service utilization, and pricing to assist with HIB 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.
Analyze provider reimbursement levels, high cost claims, costs by geographic area and place of service, and claim accuracy.
Identify enrollment and cost trends, cost-saving opportunities, and potential fraud, waste, and abuse.
Reviews and validates reports on health plan performance.
Analyzes claim data to support invoice processing. (Senior).

Health Care Services Procurement & Contract Management
Works with vendors and external partners to carry out research related to the administration of TRS health plans.
Communicates regularly with vendors to address business needs and service issues.
Reviews and analyzes various routine vendor reports on a monthly, quarterly, and annual basis.
Works with TRS' legal and purchasing departments in the renewal of contracts and amendments.
Assists with evaluating HIB'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.
Assists with the development of procurement documents, such as statements of work and evaluation criteria.
Negotiates business and financial terms of contracts with vendors and finalizes contract documents. (Senior)
Program Administration
Researches, recommends, and implements methodologies for reporting health care data and statistics including key performance indicators for program activities.
Regularly communicates with vendors related to plan performance and 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 HIB in analyzing program data and developing key performance indicators and dashboards as needed.
Monitor vendor performance in areas of cost trends, service/process quality and delivery, implementation of plan initiatives, and contract compliance.
Review claim and enrollment data to provide support for invoice processing and benefit decision-making.
Participates on special projects, task forces, and committees as needed.
Coordinates and oversees internal and external audits of contractors and resolves audit findings. (Senior)
Addresses and resolves non-compliance or subpar performance issues with contractors. (Senior)
Performs related work as assigned.

WHAT YOU WILL BRING:
Required Education
Bachelor's degree form an accredited college or university in accounting, finance, mathematics, statistics, business, health care administration, or a closely related field.
High school diploma or equivalent and additional health care industry, benefits and/or health insurance claims processing, research, data and/or financial analysis, accounting, auditing or other directly related experience may substitute for the required education on a year-for-year basis.
Advanced degree in actuary science, accounting, finance, mathematics, statistics, business, health care, health care administration, or closely related field may substitute for one year of the required experience.
Required Experience
Three (3) years of full-time experience in analyzing health care claims data or administration of a health insurance plan.
Senior Required Experience
Five (5) years of full-time experience in analyzing health care claims data or administration of a health insurance plan.
Preferred Qualifications
Advanced degree in actuary science, finance, mathematics, statistics, business, health care administrations, or closely related field.
Experience in pharmacy benefits, analyzing pharmacy claims, formularies, or contracts within the last six (6) months.
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.
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.

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.