New Century Health merged with Evolent Health in 2018 and continues to lead transformative change in specialty care management as an Evolent company. Within the Evolent ecosystem of provider-centric solutions for value-based care, our New Century Health team focuses on cost and quality improvement for oncology and cardiology specialty care. With more than 15 years of proven results, New Century Health generates insights and drives cutting edge innovation through its clinical capabilities and deep understanding of health care informatics, physician management and health care technology systems development. Together, Evolent and New Century Health are harnessing the power of our combined organizations to improve the health of the nation. Join the New Century Health team and put your passion to work for transforming the U.S. health care landscape for patients, providers and payers.
SUMMARY: The Healthcare Analyst provides clinical and financial analysis and reporting for the company's existing clients and provides support for pricing new business.
ESSENTIAL DUTIES AND RESPONSIBILITIES: includes the following. Other duties may be assigned
* Acts with honor and integrity, serving as a role model for the company.
* Analyzes prospective and current client utilization data to identify utilization trends, calculate cost of healthcare and identify opportunities for New Century Health to add value to customers.
* Works with internal business customers to define report and dashboard requirements for use in managing day to day operations more efficiently.
* Assists with the QC/Validation of the data currently being developed into the data warehouse.
* Validates the completeness of potential client data files using various techniques.
* Extracts and compiles both internal and external data elements used in all aspects of the business from client pricing, medical cost management, operational reporting and general financial analysis as required.
* Populates existing pricing model with potential client information and makes suggestions on potential improvements to the model or corresponding presentation/reporting.
* Participates in or conducts presentations to prospective clients regarding New Century Health's pricing methodologies.
* Reconciles capitation payments to eligibility data to ensure monthly payments received are accurate.
* Calculates and analyzes monthly capitation payments made to network providers; identifies and investigates unusual fluctuations and determines root cause of potential problems.
* Conducts recurring and ad hoc provider utilization analyses; prepares meaningful, professional reports for health plans.
* Respects and maintains HIPAA confidentiality guidelines.
* Acts as an interdepartmental liaison between all New Century Health offices, departments, and committees.
* Performs other duties as assigned.
QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE:
* At least a Bachelor's degree with emphasis in Economics, Computer Science, Statistics, Math or Business, or equivalent work experience.
* Minimum of 2-4 years' work experience in an analytical role.
* Master degree in a quantitative field preferred.
* Work experience with line item healthcare claims and PBM information is preferred.
* Must have knowledge of Medicare and Medicaid regulations.
* Prior successful experience with CMS and State Medicaid agencies preferred.
OTHER SKILLS and ABILITIES:
* Must have experience and proficiency leveraging SQL, including loading data, writing update and select statements, and joining tables.
* Tableau expert experience a must
* Experience with Excel spreadsheets and other office productivity applications to share and present analytic results.
* Experience with statistical analysis tools such as SAS.
* Experience with business Intelligence tools such as Tableau.
* Ability to understand and work with a variety of data formats to create charts, graphs, tables, and other visual means of representing key aspects of the data.
* An understanding of CPT, ICD-9, Revenue and DRG codes is preferred.
* Strong written and verbal communications, including the ability to summarize the results of data analysis for technical and non-technical audiences. Must also be comfortable presenting this information via in person meetings as well as webinar technologies.
* Experience with technical writing preferred.
* Must have strong analytical skills with the ability to develop advanced analytic models (e.g. forecasting).
* Must be skilled at prioritizing assignments and working to ensure all mission critical timeframes and deadlines are met.
* Must be able to work independently and demonstrate initiative and problem solving skills working within a fast paced start up environment.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear.
* The employee frequently is required to sit.
* The employee is occasionally required to stand and walk.
* The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* The noise level in the work environment is usually moderate.