The Managed Care Data Analyst is responsible for managing the data that supports AltaMed’s managed care initiatives. The primary responsibility is the maintenance and enhancement of an integrated network of databases used to gather multiple sources of data, help the managed care department calculate incentive payouts, analyze the performance of each provider, and audit/reconcile health plan data submissions. Secondary responsibility is the production of analytical reports on provider health plan listings, provider performance, HCC/RAF and quality measures, and research of additional data sources that could benefit managed care operations. Position responsibilities can also include automation analyses and implementation, and providing data to help manage innovative projects and ideas.
Integrates/interfaces data from AltaMed’s electronic health records, specialized software, and outside sources related to managed care operations, provider data management, provider performance, HCC/RAF, quality metrics, and incentive payouts into working databases.
Uses MS access, sequel, and EA data to build queries, forms, and reports. Uses task scheduler to automate processes, data compiles, and daily tasks.
Identifies low/high performing providers and programs alerts and notifications to appropriate departments/staff members.
Collects data from quality improvement, managed care finance, HCC/RAF, EA and calculates the moniuebi-yearly provider incentive payout.
Builds and maintains ad-hoc reports, for provider data management units, to track AltaMed provider network accuracy, provider panel status, enrollment IDs, and discrepancies between AltaMed core systems.
Analyzes data from provider oversight, managed care finance, claims, ARU, quality, HCC/RAF, EA, and other sources.
Reconciles encounter data submissions. Works with health plans to receive RAPS return files and confirmed diagnosis/procedure codes. Performs data gap analyses and submits supplemental data through the health plan respective submission method.
Streamlines data collection and reporting sources to improve accuracy and efficiency.
Enhances integrated network of MS Access databases to an SQL database while maintaining enterprise wide data collection and usage.
Evaluates proprietary patient, clinical quality, financial performance, claims, and other data from AltaMed’s data warehouse and enterprise data systems for use in innovative projects.
Analyzes external health industry benchmark data to determine AltaMed’s comparative performance in clinical quality, cost efficiency, and patient experience.
Leads and manages data analysis projects, including the use of quantitative or predictive analytics that support AltaMed’s integration, growth and maximizing value strategic initiatives.
Reviews health policy and health care industry information sources to stay current and inform key stakeholders on emerging health care industry issues.
Creates summary and detailed informational reports and presentations for AltaMed leadership and management to support business decisions that enable AltaMed to achieve its strategic goals and objectives.
Cultivates and maintains partnerships and collaborations with internal and external business partners.
Assists members of AltaMed’s Business Intelligence community and other departmental team members in accessing and analyzing health care data and information.
Aptitude to learn and implement new programs and innovative projects efficiently.
Bachelor’s degree in a healthcare related or an information technology field of study.
A minimum of two (2) years of experience in analysis of health care operations, patient, clinical quality or financial data.