Medicare Data Analyst

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Job Summary

This position is responsible for data analysis relating to the Medicare line of business to assist leadership with review and decision-making. Additionally, this position is responsible for the monitoring of departmental data used for metrics and measuring line of business performance, as well as conducting market research and competitor performance. This position reviews and responds to ad hoc business questions and issues, interprets data, formulates reports, and makes recommendations based upon research findings.

Essential Responsibilities

Analysis and Reporting

Evaluate line of business priorities and develop reporting systems for use at the program manager, director, and senior leadership levels to assess the effect of key program and policy decisions; provide recommendations based on analysis.
Develop, produce, implement, and maintain department dashboards and reporting tools that convey status of key process and outcome metrics for program management and evaluation using Tableau software and other tools.
Deliver reports, dashboards and analysis to department and organizational stakeholders and other audiences as necessary.
Identify analysis and reporting needs of the line of business to extend, create new analytics and reports as needed.
Conduct data analyses using traditional and advanced methods; analyze data and information in order to identify opportunities for product, programmatic improvement, and department deliverables.
Perform analysis for explaining trends, unexpected changes and outliers.
Review metrics and reports on regular basis.
Authoring reports containing actionable recommendations
Making presentations answering questions and instilling confidence

Data Stewardship and Collaboration

Develop and maintain deep understanding of data, data infrastructure and processes used for reporting department metrics and for measuring program performance.
Develop and maintain technical documentation such as data dictionaries and glossaries for relevant data and reports.
Create line of business level curated data sets for consumption by others in the department or organization.
Participate in community of practice to represent Medicare line of business needs, to share knowledge and best practices.
Works collaboratively with internal stakeholders, leaders, and staff across the organization to obtain the data necessary for marketplace analysis and reporting.
Collaborate with the IS Business Intelligence team to improve administrative data collection, define data elements for the reporting dashboards and finalize reporting specifications.
Plan, coordinate and collaborate on data, reports and information with other departments and be available as a subject matter expert.
Perform QA on final reports utilized internally and with external partners that have been built by others.

Market Research

Keep current on systems and data sources including: Sales Force/QNXT reporting, enterprise data warehouse, CMS.gov and internal data sources such as SharePoint and Tableau.
Utilize marketing processes to provide market segmentation analysis, consumer insights, needs assessment, and technology scan with the ability to synthesize the information into a “where to play” Portfolio in Core and Adjacent markets.
Analyze and assess present and future needs, trends, challenges, and opportunities.
Collaborate with marketing and communications staff; assist with communicating brand perception and reputation, focus groups, and leaders to understand and document the business objectives.
Gather and document business requirements and research resources to perform and/or support analysis and recommendations.

Organizational Responsibilities
Perform work in alignment with the organization’s mission, vision, and values.
Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals.
Strive to meet annual business goals in support the organization’s strategic goals.
Adhere to the organization’s policies, procedures, and other relevant compliance needs.
Perform other duties as needed.

Knowledge, Skills and Abilities Required

Knowledge of or ability to learn and understand managed health care operations and remain abreast of standards
Knowledge of or ability to learn program evaluation methodologies and analytic strategies
Strong learning aptitude to research, understand, interpret, and communicate federal and state requirements relating to Medicaid and Medicare compliance and quality assurance, including the Code of Federal Regulations, Oregon Revised Statutes and Administrative Rules
Advanced computer skills including MS Windows, Word, Excel, and Outlook with proficiency using Power Point, Access, Visio, Adobe Professional, and internet browsers/search functions; SQL skills in SPSS or similar preferred
Ability to produce reports and graphic summaries using database query tools
Ability to research, analyze, assemble, summarize material, information, and data
Ability to communicate effectively verbally and in writing, including report writing
Ability to identify and anticipate issues and act proactively to formulate plans and recommendations to address potential issues
Ability to proofread materials and correspondences to correct errors
Detail orientation, record keeping, and organizational skills
Ability to work under pressure in a complex and rapidly changing environment
Ability to work in a community (internal and external) with diverse individuals and groups and provide effective support to groups of people
Ability to build and maintain cooperative and productive working relationships with other department stakeholders
Ability to identify work goals with manager and prioritize work to balance competing deadlines in a professional manner, while managing multiple tasks
Ability to work in a confidential manner with partner, member, and provider information
Significant self-direction/self-management skills with the ability to work independently and effectively as a sole contributor and as part of a team

Physical Skills and Abilities
Lifting/Carrying up to 0 Pounds

Pushing/Pulling up to 0 Pounds

Pinching/Retrieving Small Objects

Crouching/Crawling

Reaching

Climbing Stairs

Repetitive Finger/Wrist/Elbow/

Shoulder/Neck Movement

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

Standing

Walking

Sitting

Bending

Seeing

Reading

Hearing

Speaking Clearly

0 hours/day

0 hours/day

0 hours/day

0 hours/day

More than 6 hours/day

More than 6 hours/day

3-6 hours/day

3-6 hours/day

Cognitive and Other Skills and Abilities

Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Education and/or Experience

Required:

Minimum 2 years’ experience in data, business, or market analysis
Preferred:

Experience working in Medicare Advantage
Experience in claims review in public health, medical, behavioral health, dental or pharmacy areas
Experience in health care data management and reporting, preferably in the areas of quality improvement and population health
Experience querying relational databases and using statistical software such as SAS, SPSS, or Tableau to gather and manipulate data
Coursework in technology, data management or analytics

Working Conditions

Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

☐ Other_________________________________________

Travel: This position may include occasional or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used
Equipment: General office equipment and/or mobile technology
Hazards: n/a
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Position Description »