Health Care Analyst III

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.

SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

Job Description : The Job

Working under minimal supervision, support all aspects of Medicare Risk Adjustment, including data acquisition, quality review, submission to CMS and effective forecasting for both the clinical and financial impact of these data. This role will support Health Care Informatics leadership by collecting and analyzing health care related data, performing data management, quality improvement studies, conducting statistical analysis, generating reports, and providing data based recommendations to the organization's decision makers. This role will also orient, train, and quality check the work of lower level Health Care Analysts.

You Will

• Designs and conducts data management, quality improvement studies, statistical analysis, and report generation Leads consulting effort with internal and external stakeholders (including external executive stakeholders) to identify, troubleshoot and correct data anomalies and recommend further process improvements to reduce data anomaly occurrences Presents findings to all levels of management Leads the support of customer needs for what-if scenario analysis by leading the efforts of developing analytical tools / models and incorporating those tools for each customer's individual needs Mentors and audits the work of lower level Analysts before findings presented to Health Care Informatics Management Leads and manages multiple complex projects concurrently
• Performs complex analysis and interprets organizational data, including but not limited to data mining, data verification, mapping, scrubbing, and scrapping Completes them accurately within a limited time table by effectively prioritizing work and communicating workload issues to management Consults with decision makers and makes recommendations for increasing operational effectiveness Designs and conducts informal staff training and provides guidance to lower level Analysts
• Leads in the development and delivery of actionable and supportable findings within tight deadlines and changing requirements Serves as the department's subject matter expert for internal / external customers and lower level Analysts
• Designs methodology of and conducts investigative research to uncover root causes, interpret results, identify trends, and make recommendations for action. Resolves complex problems and issues and only escalates to higher levels if needed
• Monitoring and improvement of encounter (RAPS and EDPS) error rates, support of timely encounter data submission Ensures understanding of business needs by proactively developing, monitoring and clarifying the technical responses to business requirements on all Medicare related projects
• Ensures compliance with CMS data submissions by reviewing, improving and managing appropriate data QA and HCC / RAF workflow processes Develop and support risk score forecast and reconciliation process to support organization budget and accrual process Works with the Encounter data team as the Analytics subject matter expert to resolve issues and implement best practices to improve workflow processes Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN's Vision and Goals.
• Other duties as assigned.

Your Qualifications

What's in it for you?

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)