Full-Time, 40 Hours / Week
Day Shift
Remote
Must reside in OH or PA at the time of offer
Summary :
The Senior Health Plan Analytics Specialist will play a crucial role in driving data-driven decision-making within our healthcare organization.
This individual will leverage advanced analytical techniques to provide insights into payer / health plan performance, identify trends, and recommend strategies to optimize payer contract terms and address trends in payer contract performance.
The specialist will work closely with cross-functional teams, including revenue cycle, finance, operations, and clinical departments, to support the strategic goals of the organization.
Responsibilities :
1. Provides conceptual and analytic direction for developing recommendations for commercial and Medicaid fee-for-service payor contract financial proposals, using internal and external data sources as applicable.
2. Conduct detailed analysis of health plan data to evaluate performance, trends, and patterns, develop and maintain dashboards, reports and data visualizations to communicate key metrics and findings on contract performance and identify opportunities for improvements in payer contracts.
3. Present payer analytical findings in a clear and concise manner to senior leadership.
4. Acts as a liaison between the analytics team and other departments, fostering a collaborative environment.
5. Knowledge of the professional and technical chargemasters and experience with strategic pricing for contract pricing optimization.
6. Other duties as assigned by Director, Payer Contracting.
Other information :
Technical Expertise :
1. Proficiency with Excel, or similar software is required.
2. Proficiency working with hospital chargemaster, databases and contract modeling / management and reporting software required (Examples, Strata and Epic).
3. Working knowledge of the business of commercial and government health insurance (financial aspects of fee-for-service and risk-based managed care / payor contractual arrangements)
4. Excellent written and oral communication required.
5. Strong problem-solving skills required.
6. Demonstrated strong critical thinking and analytic ability required.
7. Self-starter
8. Strong interpersonal skills required.
Education and Experience :
1. Bachelor’s degree in data science, Statistics, Health Informatics, Public Health, or a related field. Master’s degree preferred.
2. Minimum of 5-7 years of experience in health plan analytics or a similar role within the healthcare industry.
3. Proven experience with statistical analysis, predictive modeling, and data visualization tools.
4. Strong analytical and problem-solving skills with the ability to interpret complex data sets.
5. In-depth knowledge of healthcare data sources, including claims, EHR, and patient registries.
6. Excellent communication and presentation skills.
7. Ability to work independently and manage multiple projects simultaneously.
8. Familiarity with healthcare regulatory requirements and industry standards.
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