GENERAL SUMMARY:
Support new healthcare data analytic capabilities for premium, enrollment, claims and non-claim expenses. Performance evaluation in terms of quality, timeliness, insights and clarity of trend opportunities and variance magnitude.
Evaluates healthcare data and create segmentation reports that include trend analysis (cost, price, and utilization); comparisons provider groups and hospital systems; Milliman benchmarking; and risk and quality measures. Data assessed is based on claims, member demographics, evidence-based measures, Global RVUs, MARA risk scores, ACA markets, provider regions and product segments. Create dashboards, report packages and visualizations for HAP leadership to ensure that convey performance patterns and areas for improvement. Monitor trends to proactively identify issues. Internal data cleansing, data reconciliation analysis and gathering business requirements as needed. Manage multiple projects and timelines effectively and communicate risks and issues to the director regularly.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
Conducts analysis associated with medical cost saving initiatives, leading indicators, rate model and pricing related data, contract efficiency with providers, and adherence to quality standards. Participates and/or leads cross-functional corporate business teams and meetings in the development of medical economics programs, targets, and results as they relate to specific corporate strategies and programs.
Develops best in class and forward-thinking methods/criteria for measuring and summarizing healthcare performance data. Integrates information from multiple sources, discerns implications for future analysis and identifies opportunities for enhancing integrity of medical data.
Prepares historical analyses (e.g., PMPM, Utilization per one thousand, and Price per resource) for targeted medical cost categories, geographies, and segments. Conducts analysis of membership mix and its resulting impact on utilization models. Validates findings against Milliman benchmarks. Utilizes baseline metrics and trends to establish medical cost savings forecast models.
Supports the development and implementation of strategic medical management and/or network management initiatives, product offerings or other strategic business programs through extraction, analysis and summarization of appropriate data sets and benchmarks.
Partners with IT, Data & Analytic Strategy, Finance, Actuarial, Sales, Product Management , Market Intelligence, Claim Services, Pharmacy Services, Provider Network Management, Utilization Management, and Population Health to champion, develop, and monitor sound cost valuation methodologies for medical and/or network management programs and initiatives.
Communicates and describes the findings to business questions and objectives pertaining to medical costs, contracting performance, and/or clinical/network performance to key leadership and/or stakeholders.
Prepares and delivers well-organized and compelling presentations to reflect key findings, analytic methods to determine such findings, future analysis, and implications; and the identifications of opportunities to drive business improvements.
Prepares reports and presentation for running the business meetings quarterly.
Performs other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
Bachelor's degree in Health Policy, Health Care Economics, Biostatistics, Epidemiology, Finance, Analytics, or other closely related field required.
Master's degree preferred.
Minimum of three (3) years of progressive analytical experience in a healthcare or managed care/insurance related setting.
Minimum of one (1) year of experience in leading staff in projects or supervisory/management position preferred.
Skills required: SQL, Excel.
Skills preferred: Microsoft PowerBI, Azure and MedInsight.
Demonstrated experience with data interpretation, analysis, and reporting; clinical and financial data; risk modeling and forecasting; key performance indicators as it relates to medical cost data.
Demonstrated project management experience in running corporate wide projects.
Experience in mining and migrating medical cost performance data to a single platform preferred.
The nature of the work requires progressive interpersonal communication, decision- making, financial and technical skills. Ability to ideate, improve processes, calculate measures, and leverage BI solutions to improve healthcare performance.
Must exhibit the ability to function in an autonomous manner in a rapidly changing environment.
High energy: strong leadership, analytical, project planning and coordination skills to enable efficient, timely task completion of deliverables that meet or exceed customer expectations.
Demonstrated ability to function in a creative, "out-of-the-box" way of thinking to develop original solutions to overcome roadblocks and meet or exceed customer requirements and expectations.
Knowledge of medical claims data and managed care membership data.
Knowledge of business intelligence applications, data, and tools.
Advanced Microsoft analytic skills (e.g., Access , Excel, and PowerBI.
Knowledge of Medicare and Commercial Reimbursement methodologies a plus.
Additional Information
Organization: HAP (Health Alliance Plan)
Department: Data Analytics
Shift: Day Job
Union Code: Not Applicable
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services - from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers .
Benefits
The health and overall well-being of our team members is our priority. That's why we offer support in the various components of our team's well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.
