Healthcare Business Intelligence Analyst
Healthcare Business Intelligence Consultant
The position will perform a variety of data analytics, will develop program reports and dashboards, provide leadership to a small project team, and provide staff training in all these areas.
Specifically, the position will support health insurance initiatives by analyzing and discussing population health, cost, utilization, cost/benefit, data quality, financial trends, health plan and provider performance, provider network access, clinical quality performance, and health outcome gaps with team members.
In addition, the position will be responsible for working with staff to identify business needs and design, develop and deliver a variety of reports and dashboards to make data available for management of the program. The HBIC will also be responsible for training others on the availability and use of reports and dashboards.
The HBIC will work with others to determine business requirements, priorities, define key performance indicators (KPI), and develop the business intelligence and data management strategy.
1. Duties and Responsibilities:
a. Business Requirements and Analysis
i. Perform analysis for a wide range of requests using data in different formats and from various platforms.
ii. Research problems and create models that help analyze these problems.
iii. Make recommendations after exploring data and discovering patterns, meaningful relationships, anomalies and trends. Communicate the results of this exploration to partners and explain its meaningfulness. Recommend potential program opportunities that could result.
iv. Collaborate with staff to identify analytic and reporting needs and develop appropriate reporting as needed.
v. Design, develop and deliver analytic projects as assigned, including delivering analytics insights and making health plan recommendations as appropriate.
vi. Work with staff to develop and prioritize an analytics calendar which anticipates the analytics activities to be completed over a given year.
vii. Recommend to leadership to improve the design and development process and delivery of reports and dashboards, as appropriate.
viii. Recommend to leadership opportunities for cost savings or areas for program improvement based on insights developed through analytics projects.
ix. Develop and deliver monthly and other regular reporting on program expenditures, service utilization, enrollment and other areas to meet business needs.
b. Quality Metrics
i. Recommend and monitor healthcare quality metrics and ensure quality metrics are documented, tracked and trended (e.g. NCQA, HEDIS, AHRQ ACO, MU).
ii. Document, model, create, refresh and monitor healthcare quality metrics in scorecard and/or dashboards.
iii. Participate in policy development to encourage improvement of quality metrics.
c. Research and Evaluation
i. Research best practices, tools, frameworks and mechanisms for data analytics and healthcare informatics.
ii. In conjunction with other key staff, approves selection of tools, frameworks and mechanisms for data analytics.
iii. Stays abreast of business strategies and direction.
iv. Interfaces with vendors to keep abreast of new technologies, pricing and customer applicability.
d. Data Governance
i. Adheres to healthcare industry current policies, standards and procedures.
ii. Recommend standards, policies and procedures for the form, structure, and attributes of BI tools and systems.
iii. Staff the Data Governance Council and support policy development process.
iv. Make recommendations to leadership and the Data Governance Council on how data can help inform decision-making.
v. Monitor data quality and identify opportunities for improvement, as appropriate.
i. Design and deliver end-user training and training materials.
ii. Train ETF users to transform data into action-oriented information and to use that information correctly.
iii. Provide coaching, guidance, training, and problem-solving assistance to other team members on the use of and health care data and business intelligence tools.
iv. Train other users on the use of reports and dashboards, as appropriate.
i. Provide leadership to the project team to ensure that best practices are followed for BI, data warehousing, and data governance.
ii. Plan, organize, prioritize and monitor technical work effectively to meet key milestones and business objectives.
iii. Facilitate meetings to elicit requirements for the reporting needs.
iv. Provide coordination for technical tasks and problem resolution.
v. Guide understanding of how business processes and future business needs are impacted by the system data, database components, data element relationships, principles and guidelines governing its use, distribution, and maintenance.
a. Bachelor's degree in Applied Mathematics, Statistics, Computer Science, Economics or specialized training/certification. Or equivalent work experience.
b. Requires 7 or more years of healthcare Business Intelligence/Analysis, Data Analysis or related technical experience.
c. Requires 7-10 years’ experience inthe healthcare or insurance industry.
d. Advanced degree in Healthcare Informatics preferred.
3. Core Competencies
a. Healthcare Business Knowledge
i. Possesses a deep understanding of multiple, major components of health care providers and insurers.
ii. Understands the present state of the health care industry and can identify target markets, pricing structures and players.
iii. Has knowledge of specific markets, trends, technologies, and economies that directly impact health care businesses and can make recommendations for improvement based on research findings.
b. Healthcare Data
i. Extensive knowledge of health claims data and payment principles for inpatient, professional, and pharmacy claims.
ii. Ability to integrate membership, provider, claims and other data sources for analytic purposes.
iii. Ability to apply health plan, hospital and physician performance measures and their associated methodologies and data sets.
iv. Extensive knowledge of healthcare quality metrics (e.g. NCQA, HEDIS, AHRQ ACO, MU), including their development, application, use, and limits.
v. Knowledge of ICD-9/10 diagnosis codes, service procedure and modifier codes.
c. Business Requirements Analysis
i. Able to review business requirements and recommend solutions that can be integrated and deployed in the environment.
ii. Can document the interrelationship of businesses and technologies, outlining dependencies and risks.
iii. Able to evaluate the cost effectiveness and potential benefits of proposed interventions versus alternative options and can identify the strategic value of each option.
i. Ability to effectively communicate orally and in writing one on one and with groups at all levels.
ii. Presentations demonstrating problem resolution, convey important themes, insights and conclusions appropriate for the audience.
e. Information and Analytics
i. Possesses extensive knowledge of research and analysis methods and tech¬niques.
ii. Evaluates sources, and collates and compares findings for bias, omission and accuracy.
iii. Ability to draw insights and make conclusions and recommendations based on the results of research and analysis.
iv. Knowledge of policy and program development principles and techniques.
v. Knowledge of techniques and methods used in policy and issue analysis.
i. Utilizes visual business intelligence tools such as Tableau to create custom reports, and dynamic dashboards.
ii. Intermediate/advanced level skills with MS Excel, Access, Visio, and PowerPoint.
iii. Utilizes statistical programs such as R and SQL.
g. Other Preferred Competencies
i. Ability to read and interpret policies, procedures, guidelines, rules, and regulations.
ii. Ability to analyze and interpret federal and state legislation.
iii. Ability to prepare and present reports based on policy, salient state and national trends and data analysis.
iv. Working knowledge of state and federal laws, rules and regula¬tions governing the health and other insurance benefit programs
v. Working knowledge of philosophy, principles and practices of group health insurance, life, and other insurance benefit programs.
vi. Working knowledge of state and federal programs, policies, and procedures that impact the state group health, life and other insurance benefit programs.
vii. Working knowledge of actuarial principles and practices.
viii. Knowledge of methods and techniques for gathering