Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Lead Data Analyst, Medical Management Operations

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Manager & Professional
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190Q8 Requisition #
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Responsible for development of reporting and analytics to drive change and measure health care value. Create information that will empower internal associates to identify areas of opportunity to make meaningful changes to the cost and quality of health care being delivered to Plan members.

 

Responsibilities:

  • Develop operational reports that allow management to effectively manage the business.

  • Work with internal stakeholders to determine appropriate information for corrective action management reports. 

  • Evaluate current systems against new business needs; gather and document business requirements; ensure innovative, efficient solutions delivered are designed to meet business needs.

  • Develop, implement, and maintain leading-edge analytic systems, taking complicated problems and building simple frameworks.

  • Conduct and coordinate cross-functional analysis of health care data to identify trends, explain results, and discover opportunities for improvement. 

  • Create and maintain rich interactive visualizations through data interpretation and analysis integrating various reporting components from multiple data sources

  • Communicate findings to clinical operations management and appropriate stake-holders.

  • Design, develop, and implement ongoing data validation processes.

  • Derive and validate universes required for quality monitoring and auditing, state, federal and accreditation audits.

  • Identify areas for data quality improvements; help to resolve data quality problems through the appropriate choice of error detection and correction, process control and improvement, and/or process design strategies.

  • Contribute to planning by determining what information is necessary to make valid decisions, generating the necessary information, and analyzing the information and making recommendations.

  • Act as the liaison between Medical Management Operations and Technology to resolve production issues.

  • Serve as subject matter expert in data/analytical related functions.

  • May guide and mentor less experienced analysts.

  • Develop standard and ad-hoc reporting and analysis as required.

  • Perform other related projects and duties as required, directed, or assigned.

Qualifications:

  • Bachelor’s Degree in Actuarial Sciences, Decision & Information Sciences, Medical Informatics, Finance or related quantitative field; Master’s preferred

  • 5-8 years of experience in the design, development, and management of informational analysis tools required

  • Previous work experience in utilization management and trend analysis, preferably within a managed care environment required

  • Must have previous work experience in interpreting financial results and explaining variances required

  • Ability to use raw data to create meaningful reports through working knowledge of relational database principles including SQL and MS-Office products (particularly MS-Access) required

  • Experience with Tableau preferred

  • Excellent quantitative and analytical skills required

  • Knowledge of medical terminology and coding methodologies required.  HCPC, CPT, RBRVS, Diagnosis (ICD-10), DRG's required

  • Good oral and written communication skills with work experience in presenting analysis to key stakeholders to support strategic business decisions required

  • Good project management skills required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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