Reporting to a Functional Program Analyst 4, these positions are responsible for performing the following duties to include, but not limited to:
- Compiling, organizing, analyzing, and interpreting healthcare data provided by multiple sources. Investigates data to find patterns and trends.
- Reviews network access reports to create trend analyses and summaries for decision-making purposes including, disruption analysis for assigned markets and networks. Assimilate large quantities of simple and moderate data into meaningful formats for tracking and status inquires.
- Communicates with insurance companies, attorneys, consumers, and OIC staff regarding network access reports, market availability, laws, and regulations.
- Develops reports utilizing insurance company’s data to assist management in making determinations about network compliance with state and federal law.
- Performs research and analysis for low-impact (simple) network access proposals for consumer inquiries and referrals from Consumer Advocacy and Market Conduct units.
- Provides analysis and interpretation of technical healthcare data filed within federal binder templates required by the Affordable Care Act certification process to participate on the Health Benefit Exchange.
Bachelor’s degree in Public Administration, Business Administration, Social Sciences, or a closely related field from an accredited institution whose accreditation is recognized by the U.S. Department of Education or the Council of Higher Education Accreditation or a foreign equivalent.
(Additional relevant professional experience working in the healthcare, insurance or regulatory field interpreting, analyzing or reporting on statutory requirements will substitute year for year for education.)
Two years of professional work experience in one or more of the following:
- Ensuring compliance with governmental statutory and regulatory requirements; or
- Professional work with Health & Disability insurance, Self-funded plan, or Provider Relations; or
- Experience related to healthcare claims payment configuration, credentialing, or utilization process/systems and the relevance on network operations impact; or
- Experience analyzing data using business intelligence software and creating data visualization reports for a variety of audiences.
Intermediate level Microsoft Office Outlook with the ability to set calendar options; sort, find and filter messages; customize message options; use the journal entry to track and record; assign, reply and track tasks; create public folders and send and post information.
Intermediate level Microsoft Office Word with the ability to create, save, preview and print documents; edit text, format documents; and use auto-correct.
Intermediate level Microsoft Excel skills with the ability to create and edit macros, perform conditional formatting, apply data list outline, consolidate data and link workbooks, export and import text files and XML data; import data from the Web and create Web queries, analyze data using trend lines, Sparkline’s, and scenarios.
- Working toward or have an industry specific designation such as Certified Health Data Analyst (CHDA), Registered Health Information Technician (RHIT);
- Experience drafting, analyzing, researching, or applying the provisions of provider and facility contracting.
- Intermediate skills in Microsoft Power BI with the ability to create reports, extract data design and edit reports.
- Previous healthcare analytics experience directly assisting in preparation of monthly, quarterly, and annual data reports for state or federal reporting for assuring compliance with healthcare statutory requirements such as Title X, Medicaid, or Medicare.