Job Description

GOLD KIDNEY CORE VALUES:

Gold Kidney Health Plan is a people business. Our success depends on having the best and brightest employees and helping them attain their personal and professional goals while delivering excellence in patient care and business results. Our employees embody our culture, which is based on six core values supporting our promise to improve the quality of life of every patient every day. These core values are Patients and Partners First, Honesty and Integrity, Quality and Compliance, Collaboration, No-Limits Mindset, and Results Oriented.

PURPOSE AND SCOPE:

The Healthcare Data Analyst will have extensive data analyst experience partnering with internal and external stakeholders. You will also be developing and maintaining data software applications based on business and customer requirements, planning, and executing complex claims analysis, defect mediation, and testing within set deadlines. In addition, this role is reviewing and recommending changes to existing processes and procedures to guarantee quality. The Healthcare Data Analyst will work with Operations Leadership to provide oversight to the Operations team or similar resources within Gold Kidney’s Organization.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Preparing analyses related to hospital inpatient databases and provider claims data.
• Gathering and synthesizing data from various sources (e.g., CMS, CAQH, Claims, Member, Provider Databases, etc.)
• Building flexible, dynamic, and scalable financial and operational models to forecast trends, preparing scenarios for consulting efforts related to delivery and business development (e.g., strategic planning, operational improvement, market assessments)
• Enhancing existing models and capabilities built using SQL, primarily, with the use of Python,
• Performing complex analyses of big data, including cleaning, preparing, and interpreting
• Communicating market insights to pursuit teams, and supporting business development efforts
• Configuring, maintaining, and building flexible reports, queries, and visuals within the Power BI environment and the production and development environments of related databases
• Researching, testing, and implementing solutions in Power BI
• Partnering with various consulting units (strategy, academic health, provider financial services, performance transformation, etc.) to gather requirements related to data analytics.
• Creating and maintaining analytical support documentation and operating procedures
• Developing new and innovative methodologies and approaches
• Assisting the Sr. Director Operations in developing analytics and data strategy to support data analytics capabilities.
• Responsible for accurate, timely maintenance of complex provider information and synchronization of data on all claims and provider databases including expertise on business requirements for multiple business regions.
• Participates in system testing and analysis in support of new functionality, new system processes, and business rule changes.
• Researches and resolves complex exceptions and error reports and determines regional/cap/business indicators for multiple business areas to assure accurate reimbursement based on provider contracts and area fee schedules.
• Interprets update requests and coordinates with internal and external customers to clarify and complete.
• Applies standard techniques and procedures to routine instructions that require professional knowledge in specialist areas.

PHYSICAL DEMANDS AND WORKING CONDITIONS :

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions.

SUPERVISION:

• No supervisory responsibilities

EDUCATION:

• A bachelor’s degree in computer science, computer engineering, mathematics, statistics, health information management, health administration, business, or a related degree that relies heavily on critical thinking, logic, and math or 5+ years equivalent work experience in healthcare.

EXPERIENCE AND REQUIRED SKILLS :

• Prior data analytics work experience using databases, SQL, and Power BI in a healthcare or enterprise environment (five+ years of experience for senior analyst level; one to three years for analyst)
• Experience using Python, Power BI, SQL
• Proficiency in Microsoft Word, Excel, and PowerPoint
• Comfort with manipulating and synthesizing large data sets.
• Strong written and verbal communication skills
• Excellent organizational skills

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