PEHP - Health Data Analyst II

Description:
A division of Utah Retirement Systems, PEHP is a non-profit trust with the vital job of providing health benefits to Utah’s public employees and their families.


Job Description:

Summary:

Conducts cost and statistical analysis of business processes, medical and pharmacy claims data, and presents strategies for the organization to enhance decision-making, reduce costs, and increase efficiency and effectiveness.  Designs case selection criteria and variable parameters for routine and ad hoc analysis.  Updates, maintains and assists in managerial reporting processes.  Prepares reports for dissemination and presentation.  Ensures integrity of reports and actively researches and corrects any inaccuracies discovered



Duties and Responsibilities:

        Analyzes a wide variety of data and information.  Identifies utilization, cost, and risk trends. Recommends strategies to the Director of Analytics to enhance decision-making, reduce costs, and increase organizational efficiency and effectiveness.
        Analyzes data from various database structures, such as claims (medical, pharmacy and dental).  Selects data and ensures the accuracy of the data in a timely manner.
        Utilizes PEHP software to maximize utility and scope of data to establish market advantages and to manage efforts to provide price information to senior management, members, and employers.
        Creates models to analyze data and forecast the impact of formulary, benefit and contract changes.
        Creates tools for departments to gather data and generate reports.
        Coordinates efforts with Underwriting staff to ensure case management and pharmacy department efforts are focused on reducing costs while maintaining or improving quality outcomes.
        Identifies members experiencing health episodes which might be managed under a case management process for referral to case managers.
        Identifies members who may benefit from disease management, adherence and pharmacy management programs.
        Analyzes provider data.  Identifies provider patterns indicating where case management techniques might be beneficial.
        Calculates effectiveness of care levels by provider and facility.
        Presents data and conclusions to the Director of Data Analytics and senior staff.
        Prepares reports and trains staff on interpreting results.
        Investigates and takes action to correct any discrepancy in the data to ensure the integrity of the reports.
        Links databases to facilitate departmental and company reporting objectives.
        Tracks medical and pharmacy trends on a monthly basis segmented by disease, diagnosis, drug, therapeutic category and medical codes.
        Maintains a record of case management and pharmacy practices and trends to measure ROI.
        May provide ad hoc analysis and support for other PEHP Departments.
        Participates on committees and taskforces as assigned.
        Maintains strict confidentiality.
        Performs other related duties as required.

Qualifications:
Education and Experience

Bachelors degree and three (3) years working experience with data analysis in health administration with either an insurer or medical provider (physician, hospital, etc.); or an equivalent combination of education and experience.



Knowledge of SQL, Tableau and medical claims payment process is preferred.


Apply:
https://careers-urs.icims.com/jobs/2142/health-data-analyst-ii/job