Senior Healthcare Analyst, Remote

Senior Healthcare Analyst, remote

Cost and Utilization:

• As part of a team, participates in the development and ongoing enhancement of cost and utilization reporting to meet the needs of medical managers as well as business and finance managers
• On a regular and ongoing basis analyzes and interprets cost utilization information; identifies key drivers and underlying issues; performs appropriate drill-down queries; summarizes and present findings and opportunities
• Works with clinical and finance staff/managers to ensure the accurate capture and reporting of authorization information

Clinical Program Evaluation:

• Drives the development of appropriate program metrics and outcomes during the design phase of new clinical programs with an understanding of available and reliable data at
• Designs and conducts analyses to evaluate the overall effectiveness of clinical programs including achieving financial, utilization, and clinical program goals. Develops data queries; conducts rigorous analyses using appropriate statistical methods; interprets results and presents findings to leadership
• Collaborates with outside program vendors in analyzing and interpreting outcomes of vended programs
• Quantifies the impact of clinical initiatives on overall medical expenses and trends and works with finance and budget staff to incorporate them into the appropriate financial and budget reporting.

• Designs and executes queries and develops reports in support of ad hoc requests
• Ensure the validity and accuracy of all data/information reported and presented
• Works collaboratively with IT to: enhance automation of processes; establish data warehouse standards and definitions; and to identify new tools to facilitate standard querying and reporting
• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.

• Bachelor's Degree in a related field
• 4-6 years of analytic and/or IT experience in healthcare
• 2-3 years prior experience working with and analyzing payor claims data

• Master's degree in a related field
• Prior experience working for a health plan or in a managed care setting
• Possess strong analytic and technical skills and the ability to translate complicated data into useable information
• In-depth knowledge and understanding of health care claims data, coding schemes (ICD-9, CPT-4, DRGs), and risk adjustment
• Demonstrated knowledge of managed care concepts and the financial relationship between payors and providers.
• Demonstrated knowledge and understanding of the principles of medical and utilization management and the various types of clinical programs health plans employ
• Demonstrated knowledge of database and data structures as well as general systems technology
• Demonstrated knowledge of Power BI

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.