Job Description

Job Description

Job Description

Position is located in Wheeling WV - working onsite (3) days per week

Senior Clinical Data Analyst position will be responsible for analyzing healthcare data of the population from multiple sources (e.g. claims processing, clinical operations, analytical software and other database resources) to support decision-making for The Health Plan.

Required:

1. Bachelor or Master’s Degree related to the clinical, behavior health, healthcare, economics, or statistical data fields.
2. Experience in data collection, analysis, and visualization methods.
3. Excellent oral, written, telephonic and interpersonal skills, balancing an independent and team working environment.
4. Ability to exercise independent and sound judgment in decision making, utilizing all relevant information and data.
5. Ability to interpret complex data and communicate findings to non-technical stakeholders.
6. Flexible and able to multi-task, work in a fast-paced environment and adapt to changing processes.

Desired:

1. Previous work in a medical, managed care, payer, or data driven organization(s).
2. Proficiency in analytical tools such as Excel, SQL, and Power BI.
3. In depth knowledge of healthcare reimbursement elements including medical claims, provider, quality, and pharmacy data.
4. Familiarity with value-based care, population health management, or HEDIS/STARS quality data.

Responsibilities:

• Utilize databases, analytical software programs, and reporting tools to extract data.
• Generate reports and perform moderate to complex data analysis to identify trends within a population for potential system/process improvement.
• Analyze payer data including claims, eligibility, authorization and utilization data to identify trends, inefficiencies/opportunities within the Clinical Services department as part of the Medical Economics team.
• Develop reports and dashboards to track payer performance metrics such as cost, quality, and utilization.
• Monitor changes in healthcare regulations and payer policies, assessing their potential impacts on business strategies
• Interfacing with, gathering information from, and preparing data for presentations to various levels of management, committees, internal and external.
• Supports reporting requirements as needed for governmental and accreditation processes.

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