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  • 705 Mount Auburn Street
    Watertown, MA 02472

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Health Care Analyst II

Tufts Health Plan • Watertown, MA

Posted 27 days ago

Job Snapshot

Healthcare - Health Services
Accounting, Finance, Health Care


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Job Description

The Health Care Analyst II leads the coordination, development and improvement of the analytical services available to Tufts Health Plan's providers who have accepted meaningful risk in their reimbursement contracts with THP. Under the direction of the Provider Engagement Manager, this individual will support the efforts of a cross-functional team that evaluates the performance of providers who have accepted these models, and provides them with the data and information required to maximize the benefit of this contract model and to improve the overall quality of care delivered to THP members. This individual will work with the Commercial Provider Engagement team to anticipate provider inquiries and perform various ad hoc analyses as required. The individual will be expected to lead annual process improvements to Provider Engagement analytics and slides.

The individual will also be responsible for advanced analytical troubleshooting, assisting with building and testing new capabilities, and building code for ad hoc requests of monthly provider claims (EDD) files.

The individual will have the opportunity to assist with additional Network Contracting analyses and projects.

Support the activities of a cross-functional team charged with the following objectives:

* Produce standard reporting and analytics for risk-based providers
* Generate hypotheses for provider medical cost trends and quality performance

Initiate analyses designed to test trends, understand performance variability (at a group and physician level), and suggest opportunities for performance improvement

Lead the construction of presentations for risk-based providers illustrating conclusions to analyses and highlighting opportunities for cost/quality performance improvement

Continually identify and implement process improvements to make reporting both more streamlined and effective

Maintain two-way communications with Provider Reporting and Provider Management teams in order to monitor provider financial performance as well as inform internal business partners of providers' performance as measured by Provider Engagement

Perform ad hoc analyses as required based on provider inquiries and internal business needs

Analytical troubleshooting, capability building and ad hoc requests of monthly provider claims files.

Assist with other Network Contracting analyses and projects as required.

EDUCATION: (Minimum education & certifications required)

Undergraduate degree required

EXPERIENCE: (Years of experience)

3-5 years related experience in a managed health care environment, with experience in data modeling and analysis

SKILL REQUIREMENTS: (Include interpersonal skills)

-- Strong analytic skills and problem-solving ability

-- Excellent computer skills, including expertise in Microsoft Access, Excel, and Powerpoint, with meaningful experience in SAS and/or SPSS required

-- Experience with healthcare claims databases and claims analysis

-- Strong written and oral communication skills

-- Ability to prioritize and work on multiple projects simultaneously

-- Ability to develop productive working relationships with colleagues in other departments

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel, overtime)

Business professional environment.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or protected veteran status.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Job ID: 5000330212806
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