SUMMARY The Healthcare Data Analyst performs complex financial and statistical analyses and produces reports crucial to the operation of the Funds’ health benefits programs. The Analyst contributes to the department's efforts to meet the information needs of the Funds by combining: a working knowledge of health policy, demographic, and healthcare financing/delivery issues; a thorough understanding and command of SAS programming and other computer-based tools and analytic methods; and demonstrated ability to manage and analyze aggregate, high-volume medical and drug claims datasets along with related databases. Safe handling of beneficiary data, as well as the timeliness and accuracy of all work products, are crucial to successful completion of the Analyst’s duties. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: Performs data management, analysis, and interpretation of large healthcare datasets from multiple information systems and prepares reports of results. Tasks include: Creation of multiple working SAS datasets each month Downloading of data and reports from outside vendors Examining data and reports for anomalies and inconsistencies, always raising questions about data quality when in doubt Produces information for Trustees, internal stakeholders, outside vendors, auditors, and government programs including information such as: Beneficiary population and status Healthcare expenditures and IBNR calculations Federal program payments from Medicare Part B and RDS (Retiree Drug Subsidy) Information on disease prevalence by geographic area (using diagnosis codes, prescription drug codes, and similar information) Generates and analyzes claims runout reports and estimates outstanding gross and Medicare liabilities; estimates future health expenses based on actuarial projections; and determines allocations of Medicare reimbursement among the health plans. Applies understanding of each health plan’s financing, demographics, and plan design to ensure consistency within and among individual work products. Creates reports and analysis of vendor networks and care management programs, including such programs as DME (Durable Medical Equipment), Non-Emergency Transportation, and Hearing Aid, Caregiver Support, Complex Case Management, and an annual Flu Vaccination Campaign. Analyzes and responds to non-scheduled and ad hoc requests for statistical research and analysis. Contributes to department-wide discussions of requests and projects in terms of appropriate methodology, data sources, and any analytic problems/challenges posed by the assignments. Produces detailed analyses using mapping software packages, to support management of the Funds’ provider networks, care management programs, and other aspects of health plan operations. Reviews current academic literature and research publications and applies findings as to the Department’s analytic work as appropriate. Responsible for adhering to all Funds’ policies and procedures adopted to comply with the Health Insurance Portability and Accountability Act (HIPAA) governing the privacy, security and use of protected health information. In addition to performing the duties listed above, provides peer review to other members of the health plan staff who work on related tasks. May travel occasionally as required to conduct Funds’ business or attend professional development opportunities. Assists with special projects and day-to-day activities as required by the Department’s workload. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty successfully. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION and/or EXPERIENCE Master's degree from an accredited college or university or a comparable degreed program with concentration in economics, statistics, health services research, policy analysis, public health, healthcare financing and delivery issues, and/or program evaluation; PLUS two years of experience with healthcare data analysis, research design and methodology, and quantitative research techniques; OR, one year of experience in areas specifically related to departmental requirements, such as healthcare analytics using claims history data, medical runout/IBNR estimation, beneficiary population and provider data, and medical management program reporting. TECHNICAL, BUSINESS, and INDUSTRY KNOWLEDGE Demonstrated understanding of healthcare actuarial projections, risk-adjustment methodologies, statistical modeling techniques, survey design/sampling/analysis, and other advanced statistical methodology. Demonstrated ability to apply these tools to the Department’s work. Demonstrated ability to think through and solve analytic problems such as the many challenges posed by working with complex claims and eligibility data. Advanced knowledge of one or more areas of economics, applied statistics, health services research, policy analysis, epidemiology, program evaluation, and health care financing/delivery. Demonstrated ability to use SAS (statistical programming) functions and processing language for purposes of both data management and analysis. Ability to apply SAS programming skills to substantive analytic tasks and produce relevant and valid analyses and reports in a timely manner. Demonstrated ability to use spreadsheet applications (such as Excel), database applications (such as Access software and SQL server applications), and mapping software to accomplish complex analytic tasks involving large amounts of data. COMMUNICATION SKILLS Advanced - Ability to effectively present complex information or issues and respond to questions from groups such as managers, beneficiaries, outside vendors, or outside counsel for purposes such as resolving differences between data sources, documenting critical transactions, targeting managed care initiatives to appropriate beneficiaries, or providing other support to decision-makers. Ability to transmit key information regarding software functionality, analytic methods, and data quality issues to members of the Department and other Funds’ staff. Advanced - Ability to read, analyze and interpret business periodicals, professional journals, technical procedures and manuals, and government regulations. MATHEMATICAL SKILLS Advanced - Ability to understand and apply complex mathematical concepts such as probability and statistical inference. Ability to use concepts such as fractions, percentages, ratios, and proportions in practical applications. Ability to apply these concepts to problem-solving in the context of the Department’s work. CERTIFICATES, LICENSES, REGISTRATIONS SAS programming certification from the SAS Institute is highly desirable. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand and walk. Specific vision abilities required by this job include close vision, and ability to adjust focus. Employee is occasionally required to travel during and outside of regular business hours. Employee is frequently required to work under tight deadlines. Employee is constantly required to work in an area in which work product is subject to very precise measures of quantity and quality. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. During periods of travel, noise level may be variable. PROBATIONARY PERIOD 90 days pursuant to Sections 5.06, 5.07, and 5.08 of the Collectively Bargained Agreement.
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