Data Analyst

The primary function of this position is to provide data and analytical support for Emblem’s Two-sided Shared Risk initiative and ACO development. Major responsibilities include working with senior Two-sided Shared Risk analysts, contract managers and ACO provider entities. Assess disease burden and utilization patterns for individual provider entities’ and their managed populations. ACO reporting series will include standard ACO reports on provider clinical and care management performance. The analyst will respond to ad hoc requests with timely and actionable information to help Emblem achieve major milestones and goals for our Two-sided Shared Risk initiative.

Accountabilities:

• Assist Two-sided Shared Risk program implementation. Identify eligible member population at each provider entity level by specific products and by individual IPOs. Develop baseline information on member population assessment and provider utilization patterns.
• Using hospital, medical, pharmacy claims, and data from other sources, help identify opportunities for targeted intervention and define the clinical performance measures. Under supervision will gather data from Emblem’s data warehouse, Medstat, other systems and vendors, and will work to ensure integrity of the data from various sources.
• Create regular monthly ACO reporting package for each entity which will measure provider performance on the clinical and care management matrix as defined under Two-sided Shared Risk contract. Standardize and streamline the reporting process.
• Under guidance provide regular reports and feedback datasets to each ACO entities with timely and actionable information to facility their respective clinical intervention programs and member outreaches.
• Interact with senior analysts in responding to Two-sided Shared Risk contract managers to ad hoc data and analytical requests in support of the program and relationship management.
• Collaborate with Senior Analysts, Medical Directors and Care Management team. Will learn how to conduct evaluation studies, as needed, to assess clinical effectiveness and/or cost efficiency for specific intervention programs associated with the Two-sided Shared Risk initiative.
• Prepare documentation on reporting specification and analytical requirement to assure that the reports cre

Skills & Knowledge:

• Strong analytical and logical skills paired with strong attention to detail
• Proactive and self-motivated, and ability to take initiative in designing and completing projects
• Ability to work under pressure and meet deadlines
• Team Player, resourceful and strong facilitator
• Strong organizations skills and decision making ability
• Excellent interpersonal, verbal and written communication skills are needed to interact with all levels of staff, both internally and externally
• Extensive business understanding of the healthcare payor industry.
• Familiar with claims, enrollment and clinical data
• Working knowledge in clinical coding systems (ICD-9, ICD-10, CPT-4, DRG, etc.)

Requirements:

• Bachelor’s Degree in Statistics, Mathematics, Business, Finance or related major required
• Minimum one to three years of experience in health insurance or Healthcare Consulting experience required
• Experience in data management and clinical analysis required
• Demonstrated ability to produce reports and analyses from MS Access databases, MS Excel spreadsheets, etc.required
• Prior SAS programming experience. Knowledge of Visual Basic, and SQL programming preferable
• Familiarity with data warehouse required