Senior Clinical Data Analyst

Position Summary

Senior Clinical Data Analyst position will be responsible for analyzing healthcare data of the population from multiple sources (e.g. claims processing, clinical operations, analytical software and other database resources) to support decision-making for The Health Plan. This role performs more complex data queries, analyses and manipulations and is intended as a task/project escalation point and mentorship for the Clinical Data Analyst team.

Qualifications Required

1. Bachelor or Master’s Degree related to the clinical, behavior health, healthcare, economics, or statistical data fields.
2. 5+ years experience in data collection, analysis, and visualization methods.
3. Excellent oral, written, telephonic and interpersonal skills, balancing an independent and team working environment.
4. Ability to exercise independent and sound judgment in decision making, utilizing all relevant information and data.
5. Ability to interpret complex data and communicate findings to non-technical stakeholders.
6. Flexible and able to multi-task, work in a fast-paced environment and adapt to changing processes.

Qualifications Desired

1.        5+ years of previous work in a medical, managed care, payer, or other data driven organization(s).

2.        Advanced experience utilizing analytical tools such as SQL, Power BI, Excel, Power Query.

3.        Strong knowledge of healthcare reimbursement elements including medical authorizations and claims, provider, quality, and pharmacy data.

4.        Experience with value-based care, population health management, or HEDIS/STARS quality data.

5.        Experience mining, manipulating, and analyzing large, complex datasets.

Essential Functions and Responsibilities

• Utilize databases, analytical software programs, and reporting tools to extract data and visualize trends.
• Generate dashboards and reports and perform complex data manipulations and analysis to identify trends within a population for potential system/process improvement.
• Analyze payer data including claims, eligibility, authorization, provider and utilization data to identify trends, inefficiencies/opportunities within the Clinical Services department as part of the Medical Economics team.
• Develop reports and dashboards to track payer performance metrics such as cost, quality, and utilization.
• Serve as a task/project escalation point and mentor to the Clinical Data Analyst team.
• Monitor changes in healthcare regulations and payer policies, assessing their potential impacts on business strategies
• Interfacing with, gathering information from, and preparing data for presentations to various levels of management, committees, internal and external.
• Supports reporting requirements as needed for governmental and accreditation processes.