Business Analytics Consultant (Healthcare Data Analyst)

Rockville, MD
Sep 22, 2022
Oct 03, 2022
Analyst, Business
Full Time
Who We Are:The Mid-Atlantic Permanente Medical Group, (MAPMG) is one of the nation's premier multispecialty medical groups and is the largest integrated medical group in Maryland, Virginia and the District of Columbia. Founded in 1980, the medical group has more than 1,700 Permanente physicians spanning more than 50 subspecialties. Together, we serve approximately 800,000 Kaiser Permanente members in Maryland, Virginia, and the District of Columbia at 34 area medical centers, plus several community hospitals and skilled nursing facilities.Job Summary:We are seeking a Business Analytics Consultantto be a part of the Utilization Management and Claims Analytics Department of MAPMG. The Consultant drives strategic qualitative and quantitative analysis, including claims data analysis, in line with organizational objectives and support of overall Outside Medical referral strategy decisions.This highly visible role includes frequent interactions with mid to senior level management support teams. The Consultant provides data analysis, data visualization, report automation solutions, analytical decision support services and technical expertise across a variety of data sources including claims, the electronic medical record, and referrals reporting. The Consultant is responsible for complex multi-faceted data consolidation, integration, and analysis across multiple information platforms and functional areas throughout the organization and transforms data into actionable insights. Assists in developing performance monitoring reports and processes for claims administration. The Consultant also interprets and presents claims reports to senior leadership, collaborating with the MAPMG Regional Medical Director and Associate Medical Director of Healthcare Utilization to provide a data-driven strategic approach to claims review and external referrals.Responsibilities:In line with MAPMG's strategic mission and objectives, works closely with the Regional Medical Director of Utilization Management to plan and execute data studies and analysis used for critical decision making across the spectrum of Referrals and Outpatient Internalization.Applies advanced analytical processes to the planning, design, and implementation of financial and nonfinancial data with a focus on improving program effectivenessKeeps current with industry payment methods of reimbursement to include, but not limited to Medicare Severity-Diagnosis Related Groupers (MS-DRGs), Center for Medicare & Medicaid Services Resource Based Relative Value Scales (CMS-RBRVS)Familiarity with Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT)Works collaboratively with all vested parties within PMG and KFHP, both regionally and program wide, including but not limited to finance, medical group operations, contracting, claims administration, member services, membership administration, benefits administration, provider relations, and others.Provides analytical consulting services on the use and interpretation of analyses, reports, methodologies and source data to mid-management and senior leadershipApplies analytical, technical, and writing skills to support facilitation of executive briefingsExercises independent judgment within generally defined practices and policies in selecting methods and techniques for obtaining defined resultsDevelops project plans which identify issues, solutions, performance metrics and resource requirements in achieving department initiativesQualifications:Bachelor's Degree in business, computer science, information systems or mathematics, or equivalent experience requiredMaster's Degree preferredMinimum of four (4) years of work experience (preferably in the healthcare industry) with demonstrable results.Minimum of two (2) years of consulting/data reporting analytics experience or experience in data mining/visualization analysis toolsDemonstrates excellent leadership and collaboration abilities, along with solid time management and problem-solving skillsExperience with hospital, physician, or ancillary provider reimbursement methods for commercial and government payers Comprehensive knowledge of Medicare payment methods preferredSelf-motivated, high-energy individual with ability to work independently and multi-task in a fast-paced environmentAbility to network and build internal and external relationshipsExperience with prevalent managed care products including HMO, PPO, POS, EPO, CDHP and multiple funding options including fully insured and self-funded plansExcellent public presentation, time management, problem solving, analytical, organizational, written, and verbal skills.Expert skills with or ability to learn software including Microsoft Word, Excel, Power Point, Access, Project, Visio, SQL, SAS, Tableau, Python and Contract Management SoftwareCompetitive Benefits:Competitive compensation packageComprehensive benefits including 100% employer-funded medical and dental insurance premiums for employees and familiesGreat work/life balanceGenerous paid time offMaternity and parental leavePension plan and 401(k) retirement planLife insurance, and short-term disability and long-term disability coverageEducation reimbursementEquity, Inclusion, and Diversity:MAPMG continuously works to identify and mitigate healthcare inequities, and that starts with providing an inclusive, supportive environment for our employees. We encourage applicants of any race, color, religion, sex, sexual orientation, gender identity, or national origin who value diversity and will commit to practicing culturally competent healthcare.External hires must pass a background check/drug screen.We are proud to be an equal opportunity/affirmative action employer.