Claims Modeling Analyst (Level III)

Delaware Valley Accountable Care Organization (DVACO), located in Radnor, PA has a newly created opportunity for a Population Health, Claims Modeling Analyst (Level III).

The DVACO is a limited liability joint venture corporation comprised primarily of two major health systems: Jefferson Health and Main Line Health, serving the Greater Philadelphia region and southern New Jersey. DVACO was accepted into the Medicare Shared Savings Program for the 2014 start year, and now includes 2,000 physicians serving over 180,000 lives. DVACO contracts with four commercial payers and serves Medicare beneficiaries, making it the region’s largest Accountable Care Organization. At the core of operations, DVACO is committed to working towards the achievement of the triple aim: better outcomes, better experiences, and smarter spending. Our culture embraces innovation of healthcare delivery models through collaborative work with physician practices, health systems and employee wellness programs.

Reporting to the VP Operations, the Analyst III will be responsible for interpreting data, leveraging analytical tools and making recommendations to key stakeholder at the DVACO and JHS\MLH PODs. Is seen as a subject matter expert and will lead DVACO governance committees and maintain ongoing relationships with all levels of management, key third party staff, internal constituents and external customers at participating CIN organizations to gather information, share data and effectively move projects forward. Provides supervisory guidance to less experienced analysts and proactively coaches and mentors others throughout the system.

Accountabilities to include:

  • Works with Vice Presidents, Medical Directors, Clinical Operations, Finance, Network Contracting, IT and other Jefferson departments or stakeholders.
  • Fully responsible for interpreting, organizing, executing, coordinating, evaluating, and communicating complex projects under the guidelines of leadership.
  • Produces analytics used to measure and quantify DVACO and associated business partners’ experience through reporting using CMS data and other internal/external data.
  • Works with the DVACO clinical and financial team to identify trends and patterns in these complex data sets, draw conclusions, develop summaries utilizing charts, graphs and images to appropriately display the information for presentations to stakeholders.
  • Works with and educate the POD quality leadership, the TIN and clinical practice leadership to present statistical and operational reports of the metrics including analysis of progress towards goals and benchmarks
  • Provides analytical support (consultation, design, analysis) to business units to understand and monitor performance as it relates to cost and quality.
  • Provides direction and/or consultation on analytical approach to peers and customers. Uses business knowledge to anticipate business questions and needs and proactively identify and implement solutions. Identifies gaps in business reporting and proactively identifies and implements solutions.
  • Performs all aspects of actuarial informatics analysis including; data acquisition and data management, advanced SAS or SQL programming, advanced data visualization, quantitative and qualitative data analysis.
  • Creates written narrative summaries that compliment many of the key performance indicators and metrics, or analytics outlining trends of interest, opportunities for intervention or consideration, changes or shifts in data elements from one time period to another, etc.
  • Demonstrates initiative including recommending changes for improvement opportunities.
  • Independently evaluates and selects techniques, procedures
  • Interprets and synthesizes outcomes and conclusions

Education/Experience/Licensures & Certifications:
BS required in Business, Mathematics, IT or data relevant field. Actuarial informatics a plus.
Passage of at least two (2) Society of Actuarial (SOA) exams and active in the Exam Program
with at least 4 years of relation professional work experience OR minimum of 6 years related professional work experience in a progressive healthcare setting required.

  • Experience with Value Based Purchasing
  • Strong working knowledge of Healthcare informatics, valued based purchasing, risk score management, revenue enhancement, population health and understand total cost of care and care gaps.

Technical Skills\Capabilities

  • Maintains proficiency and expertise in Health Plan data applications, state of the art business intelligence software and reporting tools that include, but are not limited to, MS SQL Server Components (Query Analyzer & coding, Analysis Server, Stored Procedures, Jobs, and Functions), Business Objects (Tableau, Qlik, Crystal Reports, Crystal Enterprise, Crystal Analysis, OLAP, and Xcelsius), SAS, Microsoft Office (Word, Excel, PowerPoint, and Access) and grouper and predictive modeling software (3M, CGI, and MEDai) to prepare complex multi-factorial analysis. Synthesizes and Interprets analyses.
  • Must possess a comprehensive understanding of clinical or payer operational processes and ability to evaluate impacts on data compilation and reporting.
  • Knowledge of healthcare coding structures and payment methodologies.
  • Advanced programming in SAS, SQL Query Construction or other programming language.
  • Advanced understanding of relational database systems and uses.

Please apply to job id 43353. 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.