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The MetroHealth System (Cleveland, OH) · 9 hours ago

Strategic Claims Analyst- PHII-Care Delivery Brooklyn Hts

Cleveland, OH

Full-time

Onsite

Entry, Mid Level

1+ years exp

The MetroHealth System is redefining health care by focusing on community health and well-being. The Strategic Claims Analyst will manage outcomes for value-based payment agreements and support initiatives related to population health and risk reimbursement models.

Health CareHospitalMedical

Responsibilities

Supports the evolving need of managing the outcomes for value-based payment agreements with respect to governmental risk-bearing population health initiatives, including but not limited to the Direct Contracting Entity and Accountable Care Organizations

The outcomes can be related to any of the triple aim expectations of these agreements including financial outcomes, patient experience outcomes, and clinical quality outcomes

The work involves connecting the outcomes and processes to MetroHealth efforts in population health and readiness for performing under shared risk and full risk reimbursement models

In addition to reporting directly to the Executive Director, will have a dual/matrixed relationship to the Director of Business Operations and Analytics in all matters related to increasing employee’s analytics skillset, obtaining analytics best practices, and collaborating with peer analysts within the Population Health Innovation Institute and Institute for H.O.P.E

Upholds the mission, vision, values, and customer service standards of The MetroHealth System

Qualification

Financial analysisMS ExcelSAS/SQLHealthcare data knowledgeData visualizationAnalytical skillsProject valuationStatistical modelingCommunication skills

Required

Bachelor's Degree in Business, Finance or related major or any equivalent combination of education, training, and experience in addition to the experience stated below

Demonstrated actuarial proficiency or one to five years of progressive financial analytical experience in healthcare

Highly proficient in MS Excel, PowerPoint, Word

Foundational knowledge of relational database structures

Experience with SAS/SQL or similar programming languages

Experience requesting and extracting data from healthcare information systems

Strong analytical, critical thinking, forecasting, communication skills (verbal and written)

Working knowledge of healthcare data and inter-related nature of coding nomenclatures (e.g. DRG's, CPT's, etc.)

Demonstrated ability to manipulate and analyze data derived from disparate sources

Beginner to intermediate knowledge of healthcare utilization review, revenue cycle, cost allocating and their impacts on financial and strategic performance

Ability to take abstract thoughts or ideas, hone them into an analytical plan, and support leadership-ready reports

Ability to interact effectively with a wide range of cultural, ethnic, racial, and socioeconomic backgrounds