Purpose of Position
Develops metrics and reports in support of the Physician-Hospital Organization ("PHO"), also known as Cape Cod Healthcare Network ("CCHN"), to participate and perform well in value-based commercial contracts, Medicaid accountable care programs and the Medicare Shared Savings Program.

Description
1. Develops and maintains data sets to enable advanced reporting on several aspects of value-based care performance related to PHO covered lives, including cost and utilization, quality, and ambulatory care management.
2. Supports PHO case management, quality and risk coding teams with performance reports and actionable insights, including provider-level reports.
3. Maintains department operational and performance dashboards and related supporting documentation.
4. Identifies and reports on trends or patterns within administrative claims or EMR data sets; performs risk stratification analysis identifying illness burden and high-risk patients.
5. Extracts, transforms and loads administrative claims and electronic medical record ("EMR") data via flat file or query via application programming interface ("API")
6. Utilizes Cape Cod Healthcare ("CCHC") Epic and other EMRs (e.g., Athena, eClinicalWorks) to extract information relevant to analyses and validate EMR data findings.
7. Supports clinical data exchange with payers and in support of contract performance or maintenance of the provider network.
8. Assist PHO and CCHC leadership with development of analyses of contract proposals, fee schedules, charge-master changes and contract performance.
9. Utilizes good data governance standards when bringing together differing data sets by documenting assumptions, sources, methods and validating control totals.
10. In coordination with PHO staff, analyze data to view population health trends and patterns; identify individual health risks and high-risk populations; find opportunities to improve care at the population and individual level.
11. In coordination with PHO staff, develops credible metrics and internal/external benchmarks in order to measure PHO performance against "goal."
12. Consistently provides service excellence to all patients, family members, visitors, volunteers, and co-workers.
13. Challenges current working practices, identifies process improvement opportunities, and presents recommendations and solutions to management. Engages and commits to the organization's culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

Qualifications
• Minimum of Bachelor's degree or equivalent combination of education and experience to meet the needs of the position.
• 5 years of experience in healthcare informatics, managed care analytics or a related healthcare field.
• Knowledge of industry standard coding, such as ICD-10, DRG, CPT, HCPCS, and revenue codes.
• Knowledge of and experience with SQL, reporting systems, relational databases and healthcare information systems required.
• Advanced Microsoft Excel experience required.
• Ability to learn and master new information systems and data sets.
• Ability to effectively prioritize multiple demands and quickly absorb new ideas and concepts.
• Ability to present concepts and analytical results logically and concisely.
• Ability to work both independently and as part of a team.
• Confidentially maintain information in accordance with policy.
• (Preferred) Epic experience
• (Preferred) Experience with CMS Medicare Shared Savings Program structure, operations, requirements and reporting
• (Preferred) Experience with CMS claim and claim line feed files (CCLF).
• (Preferred) Experience with data visualization software such as Power BI..
• (Preferred) Experience with Microsoft Fabric, Python, JavaScript, HL7 FHIR and USCDI.