Job Description

Clinical Data Analyst

Position Summary

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.

Qualifications Required

1. Bachelor or Master’s Degree related to the clinical, behavior health, healthcare, economics, or statistical data fields.
2. 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. Previous work in a medical, managed care, payer, or other data driven organization(s).

2. Proficiency in analytical tools such as SQL, Power BI, Excel, Power Query.

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

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

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

Essential Functions

• Utilize databases, analytical software programs, and reporting tools to extract data and visualize trends.
• Generate dashboards and reports and perform moderate data manipulations and analysis to identify trends within a population for potential system/process improvement.
• Analyze payer data including claims, eligibility, authorization and utilization data to identify trends, inefficiencies/opportunities within the Clinical Services department as part of the Medical Economics team.
• Assist in the development of reports and dashboards to track payer performance metrics such as cost, quality, and utilization.
• 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

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