Principal Healthcare Analyst
This position manages complex data and information to provide meaningful results, which influence strategic decision-making at Blue Cross. The incumbent both works independently and guides teams which initiate, plan, and lead analysis from conceptual development to program implementation. Responsibilities include data management, data analysis, and the application of statistical techniques to evaluate program effectiveness, identify success factors and improvement opportunities, suggest potential solutions, and help business owners set strategic directions.
Accountabilities:
1. Leads team(s) to develop measurement plans, analyze data, and report results on health care utilization, expenditures, outcomes, and benchmarks.
2. Formulates strategic recommendations and present findings to management and external clients.
3. Conducts statistical and health-economic analysis of projects relating to clinical quality, disease management, and provider network projects.
4. Develops methods and integrate tools (e.g., ACG’s and ETG’s) which adjust for current health status and predict future healthcare utilization and costs.
5. Serves as a measurement consultant who can explain complex measurement techniques and results in layman’s terms.
6. Develops project plans, provide direction to project teams, and coordinate project activities.
7. Assists co-workers in using data/information in new and innovative ways.
Required Qualifications:
1. Bachelor’s degree in Epidemiology, Health Services Research, Social Sciences, Statistics or related field, and 5 years of relevant experience or equivalent combination of education and experience.
2. Minimum additional 3 years experience analyzing and modeling clinical data involving outcomes and utilization preferred, using various statistical software and computer programming (SAS, Visual Basic, DB2, Oracle, etc.).
3. Extensive working knowledge of clinical data quality measurements in a health plan setting such as HEDIS specification and Pay-for-Performance concepts preferred.
4. Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
5. Demonstrated ability to evaluate and interpret complex data sets.
6. Strong analytic and problem solving skills.
7. Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.
8. Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers.
9. Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/or clinical.
10. Knowledge of managed care and health care claims preferred.