DEPARTMENT: Information Systems
BASE RATE: $25.00 per hour, with potential for additional compensation based on qualifications
POSITION SUMMARY:
This position is responsible for analyzing health plan data related to health services delivery, health-care costs, quality of care, insurance coverage and access to care. The Health Data Analyst works with health plan staff to support the efforts of each department’s data analysis needs using data from a variety of sources, including medical and pharmacy claims data, hospital inpatient/outpatient data, revenue and enrollment data.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.
2. Collaborates with internal health plan staff to define data analysis projects, identify appropriate data sources, and develop meaningful and actionable output. Provides coaching and guidance to staff and acts as a resource for clinical, claims and finance staff on data analyses needs.
3. Produces and analyzes monthly data reports for medical and pharmacy expense, revenue reconciliation, clinical utilization management and claims payment. Identifies and escalates potential issues to department directors.
4. Organizes, sorts, and filters data in order to distinguish patterns and recognize trends. Develops and maintains data preparation and validation routines to support data mining. Reviews reports to ensure the accuracy and validity of presented information.
5. Utilizes tools such as SQL and Microsoft Office products (Excel, Access, PowerPoint, Word, and Visio).
6. Solves moderately complex problems and/or conducts moderately complex analyses. Escalates issues as necessary to the Data Infrastructure Manager
7. Collaborates with the Compliance Officer to provide detailed data analysis activities for potential fraud, waste and abuse identification.
8. Attends educational seminars as required; maintains knowledge of current billing, reimbursement and clinical coding schemes; attends department meetings; serves on committees and participates in workgroups as required.
9. Maintains confidentiality of client data.
10. Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS:
Education:
Minimum:
Bachelor’s degree in an appropriate science or related discipline such as health information
technology, health information management, computer information systems or related field
Preferred:
Bachelor’s degree in an appropriate science or related discipline as above with a dual major or
minor in mathematics
Experience:
Minimum:
One (1) to three (3) years of coursework related to data analysis or computer science
Preferred:
One (1) to three (3) years of experience developing reports or analyzing data in a healthcare environment
Required Skills:
• Understanding of SQL and MS SQL Server
• Excellent project management and organizational abilities
• Excellent human relation and oral/written communication
• High level of technical and problem-solving skills
• Keyboarding proficiency and advanced knowledge of MS Office (Word, Excel, Access, PowerPoint)
Preferred Skills:
• Knowledge of accounting software systems/applications
• Knowledge of claims and coding and billing methodologies
• Knowledge of clinical HEDIS, NCQA and CMS regulations
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements:
[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:
• Ability to access departmental files
• Ability to enter and access information from a computer
• Ability to access all areas of the UPHP offices
• Moderate physical effort (lift/carry up to 25 pounds)
• Occasionally lifts supplies/equipment
• Occasional reaching, stooping, bending, kneeling, crouching
• Prolonged periods of sitting
• Occasional prolonged standing
• Manual dexterity and mobility
Working Conditions:
• Works in office conditions, but occasional travel may be required
• Exposure to situations requiring exceptional interpersonal skills or periods of intense concentration
• Subject to many interruptions
• Occasionally subjected to irregular hours
• Remote work optional; based on attainment of policy eligibility criteria and subsequent application and approval
