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Data Analyst, Sr. (Pay for Value)

at CalOptima

Posted: 10/3/2019
Job Reference #: 2743
Keywords: computer, technical

Job Description

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Job Description

The Data Analyst Sr. (Pay for Value) will provide expertise in data analysis, including but not limited to member, provider, encounters and claims data; develop and design reports, create and maintain databases to support the business requirements of the team and our internal and external customers, and continually improve data acquisition and reporting methods. This position will have primary responsibility for the development and production of pay-for-value results and physician specific quality measures reports. The incumbent will assist in the development of internal systems and exception reporting to ensure timely and accurate data reporting and analysis and perform analysis of business needs and data integration with our Business Intelligence application.

Position Responsibilities:

  • Designs and generates pay-for-value (P4V) performance reports at the health plan, medical group and individual providers on defined quality performance measures. Ensures data integrity and partners with IS to resolve issues.
  • Establishes new pay-for-value metrics and/or changes in methodology in collaboration with the Pay for Value Steering Committee
  • Regularly attends Pay for Value Steering Committee meetings, P4V team and department meetings.
  • Presents pay for value results to stakeholder groups as requested.
  • Coordinates with finance to facilitate approval of payment for earned pay-for-value incentives.
  • Primary contact for data requests and assigns requests to other analysts as appropriate, monitors timeliness and outcomes.
  • Utilizes thorough knowledge of CalOptima’s data warehouse.
  • Trains and guides other analysts to improve processes, evaluate data, meet customer specifications and business needs.
  • Subject Matter Expert (SME) to QI workgroup subcommittees and other committees working on quality improvement activities.
  • Other projects and duties as assigned.
Required Skills

  • Communicate clearly and concisely writing and verbally; including trainings and public presentations.
  • Present information in a useable format.
  • Work with complex databases.
  • Work independently and as part of a team, under minimal supervision and with multiple deadlines.
  • Develop and maintain effective working relationships with other departments (i.e. IS, Population Health, Utilization Management), and various external customers.
  • Utilize and access computer and appropriate software (e.g. Microsoft Office; Word, Excel, Outlook, SQL, Access and Visual Basic for Applications (VBA)).
Required Experience

Experience & Education:

  • Bachelor’s degree in Health Care, Mathematics or a related field is required; Master’s degree preferred.
  • 3 years experience working with databases/data warehouses, data; managing, designing, gathering and interpreting patterns and trends required.
  • 5-7 years professional experience in a managed health care organization strongly preferred.

Knowledge of:

  • Pay for Value programs and reimbursement models.
  • NCQA HEDIS measures and technical specifications; familiarity working with HEDIS database.
  • MS Access and Tableau creating ad-hoc reports and design databases; strong competence with the process of data retrieval from data warehouses and databases, creating user-friendly forms and reports.
  • Excellent organizational skills and the ability to prioritize tasks and use time efficiently.
  • Medical coding, including ICD10, CPT, and HCPCS codes recommended.
  • SQL and VBA.

Grade: M


Job Location
Orange, California, United States
Position Type