Claims Data Analyst

The Delaware Valley Accountable Care Organization (DVACO), located in Radnor PA, is a limited liability company that is owned by Main Line Health, Jefferson University and Hospitals and Magee Rehab. DVACO’s purpose is to enhance the quality of health care and reduce the growth rate of health care costs by acting as a convener, accelerator, and provider of the foundation needed to assist its participating members to transition from fee for service model, a business model focused on volume to a model focused on population health.

  • Reporting to the Director of Population Health Informatics and IT, the Claims Data Analyst works collaboratively with the DVACO leadership team to develop data collection, measurement tools and databases to support the analysis of data from multiple sources, primarily claims files associated with DVACO contracts.
  • Analyzes, interprets and generates reports on performance related to overall outcomes, utilization, risk adjusted total cost of care, population health, and care coordination.
  • Develops reports, dashboards, scorecards and other analytic results necessary to support activities relating to managed care contracting, hospital and physician inpatient and outpatient quality outcomes and the quality goals set by the DVACO.
  • Works with DVACO Pods to manage the MedInsight application including monthly data refreshes, upgrades, training for end users, etc.
  • Works with payers and the DVACO data integration analyst to validate the contents of the payer claims files prior to their utilization.
  • Works with DVACO claims data files and analytics tools to monitor aggregated and drilled down performance including risk adjusted efficiency and claims-based quality metrics.

Other Accountabilities and skills:

  • Uses proprietary vendor and other software packages (e.g., MS Excel, MS Access, Crystal Reports, Visio) to create user friendly data collection systems and efficient reporting and analysis outputs.
  • Acumen and ability to work with external partner Pod, Physician-Hospital Organization (PHO), Clinically Integrated Network (CIN) or other organizations to gather information, share data, and effectively move projects forward.
  • Support clinical analytic integration across DVACO and its Pods to lead the effective use of analytic information to improve healthcare.
  • Develops and implements methods for optimizing database reliability and validity.
  • Strong conceptual analytical and quantitative skills; Strong data collection, manipulation, and analysis skills.

Education:

  • Bachelor’s or Master’s degree in Healthcare related field or in progress.
  • Thorough knowledge of actuarial and/or medical terminology and sound data analysis techniques.
  • Strong working knowledge of CMS CCLF files and attribution processes

Experience:

  • One or more years of experience working with and modeling CMS CCLF files.
  • Three (3) to five (5) years of experience with PC-based applications such as Windows, MS Office, and Relational Databases (i.e. MS Access, Excel, SQL, Oracle). Excellent skills utilizing word processing, spreadsheets and data file management software.
  • Experience in large claims data file management is required including industry standard fields and file structures.
  • Demonstrated knowledge of health insurance claims analytics, including HEDIS Quality measures, risk adjustment methodologies, efficiency of care and utilization metrics.
  • Experience developing standard and ad-hoc reports and analysis to support management decision making. Demonstrates proficiency with information systems supporting population health management and other personal computer software applications such as Microsoft Office (Excel and Access) Experience working in a large, complex, multi-site organization preferred.
  • Regional travel throughout DVACO market essential – valid driver’s license and own vehicle. Small amount of out-of-region travel as needed.
  • Able to work long hours with a varying schedule including early morning and evening meetings as needed.

Please apply to http://www.mainlinehealth.org/careers Job Id 41443 . No agency calls please. Applicants must certify that they have not used tobacco products or nicotine in any form in the 90-days prior to submitting an application to Main Line Health. This will be verified during pre-employment testing.

We are an equal opportunity employer.