Senior Healthcare Analyst
Job Location:
Somerville, NJ - USA
Monthly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are on the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we provide our membersacross Commercial Medicare Advantage and MedicareMedicaid Dual Eligible (Duals) productswith innovative highquality and affordable care.Our work centers on creating an exceptional member experience supported by rigorous medical economics and datadriven decisionmaking. Employees collaborate with accomplished healthcare professionals in a consciously inclusive environment where diversity is celebrated.
The Senior Healthcare Analyst provides valueadded analytic support in the development and monitoring of standard and ad hoc medical cost and utilization reporting for the health plans Medicare Advantage and Dual Eligible populations. As part of this work the analyst independently designs and performs complex analyses with enterpriselevel impact.
Primary Responsibilities:
Cost and Utilization:
-Participates in the development and ongoing enhancement of medical cost and utilization analysis and reporting across Medicare Advantage and Dual Eligible lines of business.
-Analyzes and interprets utilization and medical expense data; identifies key drivers including risk mix Starsrelated utilization and site of care; performs drilldown analyses; and presents findings to leadership.
-Works with clinical finance and operations partners to ensure accurate capture interpretation analysis and reporting of claims encounters and authorization data in alignment with CMS requirements.
-Supports enterprise trend management activities by monitoring emerging utilization and unit cost trends identifying variance drivers against expectations and partnering with clinical finance and operations leaders to inform mitigation strategies and performance management.
-Partners with clinical finance operations and other teams to support the delivery of regulatory reporting provider reporting and related analytic requests including Medicare Advantage and Dual Eligible reporting requirements; ensure analyses are accurate auditable and aligned with CMS internal governance and external stakeholder needs.
Clinical Program Evaluation:
-Drives the development of program metrics and outcomes during the design of new medical management care management and population health initiatives particularly for Medicare Advantage and Dual Eligible populations.
-Designs and conducts analyses evaluating financial utilization quality and clinical effectiveness of programs; interprets results and presents actionable insights to senior leaders.
-Collaborates with external vendors and delegated entities in analyzing outcomes of vended Medicare Advantage and Duals programs.
-Quantifies the impact of clinical and Starsdriven initiatives on medical expense trends and partners with finance and budgeting teams to incorporate results into forecasts and CMS bid support.
Overall:
-Designs and executes complex queries executiveready analysis and reporting in support of ad hoc analytical and regulatory requests.
-Designs develops and maintains agile ad hoc and repeatable reporting solutions using Power BI enabling business partners to independently explore data monitor performance and conduct meaningful cost utilization and trend analyses with confidence.
-Ensures validity accuracy and reproducibility of all analyses and reported information.
-Works collaboratively with IT and data teams to enhance automation establish data standards and improve analytic infrastructure.
-Anticipates internal customer needs builds trusted relationships and proactively brings forward strategic Medicare Advantage and Duals insights.
Qualifications
Education
- Bachelors degree
Work Experience
- At least 3-5 years of experience in membership claims and risk data analytics experience required
- At least 2-3 years of experience in D-SNP or Medicare Advantage
- Medicare STARS experience highly preferred
Knowledge Skills and Abilities
- Strong written and oral communication skills
- Strong attention to detail and organization
- Good analytical and mathematical skills
- Supervisor Excel skills required
- Strong ability to work independently and manage ones time
- Ability to analyze consolidate and interpret accounting data
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
- Employees must use a stable secure and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$79560.00 - $115720.80/AnnualGrade
7EEO Statement:
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Senior IC
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
