Job Description
Job Description
Leads the successful delivery of analyses and analytic solutions to meet business needs with specific focus on Risk adjustment, Revenue Integrity, and Other Health Care finance areas of concern. Interacts directly with internal and external clients and colleagues. May act as analytic team lead or mentor for complex projects involving multiple resources and tasks in support of company objectives.
- Performs applied statistical research and custom analysis of integrated healthcare data, interprets results, and makes recommendations based on analytic findings to business areas.
- Translate data into meaningful reporting/dashboards to monitor key performance indicators
- Makes recommendations about data collection methods, metrics definition and evaluation methods.
- Defines and delivers analytical solutions in support of healthcare business initiatives that drive short and long term objectives.
- Collaborates with internal and external partners and organizations in the design and execution of analytic studies to answer business and research questions.
- Designs and conducts analyses and outcome studies using risk adjustment, healthcare claims/encounters, pharmacy and lab data, employing appropriate research designs and statistical methods.
- Develops, validates and executes algorithms, statistical models and reporting tools that answer applied research and business questions for internal and external clients.
- Stays informed about industry trends, research findings and evaluation methods.
- Creates business applications to deliver clinical or analytic solutions to constituents
- Manages personal resources efficiently to achieve constituent satisfaction.
- Responsible for project commitments to quality and on-time deliverables.
- Ability to manage conflicting priorities and multiple projects concurrently
- Willingness to understand and probe into technical details
- Contributes to a motivated work environment by working effectively to achieve common goals.
- Creates and evaluates the data needs of assigned projects and assures the integrity of the data.
- Under general direction, independently executes analyses or reports to meet project needs.
- May mentor other analysts based on areas of expertise
Required Qualifications
- Strong understanding of Risk adjustment principles, models, data sources, and revenue cycle
- Five or more years of health care research, risk adjustment, finance, epidemiology, statistics, or pharmaceutical industry analytic experience.
- Strong problem-solving skills and critical thinking ability.
- Advanced SQL and/or SAS programming abilities in data warehouse or big data analytics environment, including use of statistical analysis techniques or business intelligence application development.
- Strong collaboration and communication skills within and across teams.
- Strong reporting skills using Excel, Access, Word and/or PowerPoint.
- Strong understanding of multivariate analyses, epidemiology or health economics research methods.
- Well-versed in statistical model building and concepts, decision trees and classification rules, segmentation and cluster analysis.
- Knowledge of other reporting platforms such as: Business Objects, Microsoft Access, web development technology, big data analytics, data mining, Visual Basic.
- Understanding of relational databases, data systems and data warehouses.
- Knowledge of analytic programming tools and methods (SAS, SQL, OLAP, Business Objects, Crystal).
- Experience in working in a data warehouse environment as well as the ability to work with large data sets from multiple data sources.
- Ability to communicate statistical and technical ideas and results to non-technical stakeholders in written and verbal form.
- Able to make sound decisions and recommendations to drive business solutions.
- Demonstrated extensive and diverse knowledge of health care data, metrics, systems and standards; demonstrated subject matter expert in multiple subject areas.
Preferred Qualifications
- Experience with Tableau
- Experience with Financial concepts pertaining to Managed Care; Medical Loss Ratio; Capitation,
Education
- Masters degree preferred.
- Requires Bachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Leads the successful delivery of analyses and analytic solutions to meet business needs with specific focus on Risk adjustment, Revenue Integrity, and Other Health Care finance areas of concern. Interacts directly with internal and external clients and colleagues. May act as analytic team lead or mentor for complex projects involving multiple resources and tasks in support of company objectives.
- Performs applied statistical research and custom analysis of integrated healthcare data, interprets results, and makes recommendations based on analytic findings to business areas.
- Translate data into meaningful reporting/dashboards to monitor key performance indicators
- Makes recommendations about data collection methods, metrics definition and evaluation methods.
- Defines and delivers analytical solutions in support of healthcare business initiatives that drive short and long term objectives.
- Collaborates with internal and external partners and organizations in the design and execution of analytic studies to answer business and research questions.
- Designs and conducts analyses and outcome studies using risk adjustment, healthcare claims/encounters, pharmacy and lab data, employing appropriate research designs and statistical methods.
- Develops, validates and executes algorithms, statistical models and reporting tools that answer applied research and business questions for internal and external clients.
- Stays informed about industry trends, research findings and evaluation methods.
- Creates business applications to deliver clinical or analytic solutions to constituents
- Manages personal resources efficiently to achieve constituent satisfaction.
- Responsible for project commitments to quality and on-time deliverables.
- Ability to manage conflicting priorities and multiple projects concurrently
- Willingness to understand and probe into technical details
- Contributes to a motivated work environment by working effectively to achieve common goals.
- Creates and evaluates the data needs of assigned projects and assures the integrity of the data.
- Under general direction, independently executes analyses or reports to meet project needs.
- May mentor other analysts based on areas of expertise
Required Qualifications
- Strong understanding of Risk adjustment principles, models, data sources, and revenue cycle
- Five or more years of health care research, risk adjustment, finance, epidemiology, statistics, or pharmaceutical industry analytic experience.
- Strong problem-solving skills and critical thinking ability.
- Advanced SQL and/or SAS programming abilities in data warehouse or big data analytics environment, including use of statistical analysis techniques or business intelligence application development.
- Strong collaboration and communication skills within and across teams.
- Strong reporting skills using Excel, Access, Word and/or PowerPoint.
- Strong understanding of multivariate analyses, epidemiology or health economics research methods.
- Well-versed in statistical model building and concepts, decision trees and classification rules, segmentation and cluster analysis.
- Knowledge of other reporting platforms such as: Business Objects, Microsoft Access, web development technology, big data analytics, data mining, Visual Basic.
- Understanding of relational databases, data systems and data warehouses.
- Knowledge of analytic programming tools and methods (SAS, SQL, OLAP, Business Objects, Crystal).
- Experience in working in a data warehouse environment as well as the ability to work with large data sets from multiple data sources.
- Ability to communicate statistical and technical ideas and results to non-technical stakeholders in written and verbal form.
- Able to make sound decisions and recommendations to drive business solutions.
- Demonstrated extensive and diverse knowledge of health care data, metrics, systems and standards; demonstrated subject matter expert in multiple subject areas.
Preferred Qualifications
- Experience with Tableau
- Experience with Financial concepts pertaining to Managed Care; Medical Loss Ratio; Capitation,
Education
- Masters degree preferred.
- Requires Bachelor's degree in Mathematics, Economics, Statistics, Computer Science, Actuarial Science, Social Science, Healthcare or related discipline.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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