Value Based Payment Data Analyst II

Looking for a way to make an impact and help people?

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Position Overview :

Position Overview : Primary subject of analytic support related to support of reinsurance, large employer RFP, large employer and ASO, state and / or federally mandated reporting and analyses.

Analytical role may vary and involve knowledge of value based payments, provider contract language, healthcare utilization, healthcare benefits and state and federal guidelines.

The role will also collaborate with level 3 and 4 analysts and analytics management in coordination of projects with multiple departments in supporting contractually required reporting in a timely, accurate and easy to understand format for external provider audiences.

• Additional tasks may include assisting with components of validating data used in the VBP settlement and payment processes;
• initiating documentation and processes; provides financial guidance and support; supports cost savings and process improvement efforts;

provides financial governance and oversight.

Essential Responsibilities :

Provides essential data support and coordination activities for various business critical analysis and reporting needs.

Perform accurate and complete data extraction from data warehouse as well as nonstandard data sources to meet project requirements as directed.

This would include cleaning, transformation and pre-processing data using software programs such as t-SQL, SAS, etc.

Support the development of data visualization solutions that allow customer to interact with the data using data visualization software solutions such as Tableau or Microsoft Power BI.

Develop reports and analytical solutions and processes to support the RFP process, large employer, ASO as well as various state and federal requests.

Calculate and analyze value based payment terms including development of reports, running of monthly report processes as well as reporting to support financial reconciliation processes.

Support presentation of complex data, analysis and findings to teams in a way that is clear and understandable.

Develop and maintain documentation and training materials including job aids.

Assist in evaluating impact of business changes on risk reports specifications such as plan, benefit, network, provider configuration and payment and other operational changes.

Prepare ad hoc analysis related to cost and utilization opportunities related to RFP, employer groups, ASO groups and other Sales / Marketing requests.

Assists with quality assurance adherence to ensure accuracy, completeness, and reliability of project-related information data resources and reporting initiatives such as participating in data validation projects and providing feedback on development of unit testing, error checks and validation processes.

Develop general health insurance business content knowledge as well as specific knowledge related to assigned business areas of analytics support.

Supporting Responsibilities :

Meet department and company performance and attendance expectations.

Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

Perform other duties as assigned.

SUCCESS PROFILE

Work Experience : 3 years’ experience in health insurance or related field. Healthcare analytics experience is preferred.

Education, Certificates, Licenses : Bachelor's degree in Mathematics, Computer Science, Statistics, Engineering, Health and Medical Economics, Public Health or similar research related field.

Knowledge : General knowledge of business principles, theories and concepts. Proven ability to manage multiple projects and competing deadlines.

Ability to manage workload within a team environment or with minimal direct supervision. Ability to conceptualize solutions to complex problems;

readily anticipates problems and identifies solutions. Ability to deal responsibly with confidential information. Ability to develop, document and adhere to department policies and procedures.

General knowledge of in at least one statistical / analytical programming tools such as R, SAS, SPSS. General knowledge of other technical applications such as Tableau, Power BI and web-based database tools.

Skilled in Microsoft Office : Word, Excel, PowerPoint and Outlook.

Preferred Knowledge : Familiarity with Medicare Five-Star, Oregon Quality Incentive Measures and / or NCQA HEDIS, Health Care Payment Learning & Action Network (LAN) and Alternative Payment Model framework, and Facets claims processing system.

Working knowledge of medical costs is desired, while experience with medical coding and terminology. Master’s degree or above in Mathematics, Computer Science, Statistics, Engineering, Health and Medical Economics, Public Health or similar research related field preferred.

Competencies

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

Environment : Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately less than 5% of the time.

Skills :

Accountability, Collaboration, Communication (written / verbal), Flexibility, Listening (active), Organizational skills / Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.

Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.

Communicate clearly and effectively.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.

It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.

Employment remains AT-WILL at all times.