Oversee analysis which supports the business in identifying and resolving issues and opportunities with respect to the provider network. This will include but is not limited to gaps in access to care and provider reimbursement issues.
Education & Experience
• Bachelor's degree in business, healthcare administration, actuarial science, mathematics or a related field
• 5+ years in healthcare industry
• 3+ years experience in managed healthcare analysis
• Previous management experience
• Proficient with Microsoft Excel
• Working knowledge of Microsoft Access or other database programs
• Working knowledge of business intelligence software tools
• Knowledge of VA healthcare
• Experience working for a managed care plan
• Identify provider network gaps and make recommendations to resolve those gaps
• Support the business with regard to questions regarding provider reimbursement issues
• Manage the development and production of analysis and tools that meets the needs of business and enables the identification and trending of cost trends
• Provide unbiased analytical input to management
• Provide input into the development of business intelligence and data analysis tools
• Translate business requirements to analysts and technical details back to business
• Develop strong symbiotic relationships with business departments who, as customers, consume analysis and who also serve as subject matter experts in developing analyses
• Ensure compliance with government reporting requirements
• Manages, coaches, and mentors staff
• Performs other duties as assigned
• Regular and reliable attendance is required.
Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.
Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion.
Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
Leadership: Successfully manage different styles of employees; Provide clear direction and effective coaching.
Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues
Technical Skills: Strong knowledge of Microsoft Excel; Experience with Quest Analytics and/or GeoAccess; Knowledge of healthcare reimbursement; Working knowledge of Microsoft Access, business intelligence tools, claims processing and medical management systems