Strategic Claims Analyst- PHII-Care Delivery Brooklyn Hts

Location: BROOKLYN HEIGHTS

Biweekly Hours: 80.00

Shift: 8a-5p

The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County’s safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.

Summary

Supports the evolving need of managing the outcomes for value-based payment agreements with respect to governmental risk-bearing population health initiatives, including but not limited to the Direct Contracting Entity and Accountable Care Organizations. The outcomes can be related to any of the triple aim expectations of these agreements including financial outcomes, patient experience outcomes, and clinical quality outcomes. The work involves connecting the outcomes and processes to MetroHealth efforts in population health and readiness for performing under shared risk and full risk reimbursement models. In addition to reporting directly to the Executive Director, will have a dual/matrixed relationship to the Director of Business Operations and Analytics in all matters related to increasing employee’s analytics skillset, obtaining analytics best practices, and collaborating with peer analysts within the Population Health Innovation Institute and Institute for H.O.P.E. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.

Qualifications

Required:

• Bachelor’s Degree in Business, Finance or related major or any equivalent combination of education, training, and experience in addition to the experience stated below. Demonstrated actuarial proficiency or one to five years of progressive financial analytical experience in healthcare.
• Highly proficient in MS Excel, PowerPoint, Word.
• Foundational knowledge of relational database structures.
• Experience with SAS/SQL or similar programming languages.
• S Experience requesting and extracting data from healthcare information systems.
• trong analytical, critical thinking, forecasting, communication skills (verbal and written).
• Working knowledge of healthcare data and inter-related nature of coding nomenclatures (e.g. DRG’s, CPT’s, etc.).
• Demonstrated ability to manipulate and analyze data derived from disparate sources.
• Beginner to intermediate knowledge of healthcare utilization review, revenue cycle, cost allocating and their impacts on financial and strategic performance.
• Ability to take abstract thoughts or ideas, hone them into an analytical plan, and support leadership-ready reports.
• Ability to interact effectively with a wide range of cultural, ethnic, racial, and socioeconomic backgrounds.
  
  

Preferred

• Experienced in project valuation, statistical significance testing, business case analysis and development.
• Prior Epic experience.
• Experience with data visualization programs like Tableau.
• Knowledge of artificial intelligence, machine learning, or deep learning methods.
• Experience with statistical modeling/testing and regression analysis.
• Experience with a large healthcare hospital system (public system highly desirable).
• Physical Demands:
• May need to move around intermittently during the day, including sitting, standing, stooping, bending, and ambulating.
• May need to remain still for extended periods, including sitting and standing.
• Ability to communicate in face-to-face, phone, email, and other communications.
• Ability to read job related documents.
• Ability to use computer.