Medicare QI Business Analyst Sr (Job Number:8991)
Description
Summary:
This position is responsible for obtaining data from internal and external sources, understanding relevant differences between each data source, and designing/creating database structures for analysis and reporting. This position will support the identification and development of databases to support business functions for the Medicare products, using enrollment, medical and pharmacy claims information. The Medicare Analyst analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, suggesting potential solutions, and helping Government Programs Product Management set strategic directions.
Accountabilities:
1. Identifies and documents current data flows for member enrollment attributes, such as HCC score, rate cell, care system, PCC (attributed site), care coordinator and other elements that support product management.
2. Investigates opportunities for expanded clinical data collection that are needed elements for HEDIS, CMS Stars, DHS Quality Initiatives.
3. Develops and modifies database to compile enrollment and clinical data for analysis and dissemination of information.
4. Performs complex analysis of the data. Researches, analyzes and interprets statistical data and provides technical assistance to other staff. Identifies issues to be researched, determining affected areas, estimating impact and leading the resolution.
5. Leads technical or process improvements to testing, analysis and research methods.
6. Independently manages the retrieval and analysis of data, and issues that may arise on multiple tasks or projects with limited management involvement.
7. Acts as a resource for other members of the department/division on business issues and may be responsible for training and guidance of other employees.
Qualifications
Required Qualifications:
- Bachelor's degree in related field, with 5 years related job experience, or 9 years job related experience in lieu of a degree.
- 2 years experience using various statistical software and computer programming (e.g., SAS, Visual Basic, DB2, Oracle, etc.) - Or - Requires advanced understanding/experience with multiple programming languages, systems, systems design and/or software development methodologies.
- Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
- Ability to perform validation techniques, as well as perform and interpret a variety of statistical analyses.
- Demonstrated ability to design, evaluate and interpret complex data sets.
- Demonstrated ability to handle multiple tasks with competing priorities.
- Demonstrated analytic and problem solving skills.
- Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.
- Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers.
- Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/or clinical.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job
Description
Summary:
This position is responsible for obtaining data from internal and external sources, understanding relevant differences between each data source, and designing/creating database structures for analysis and reporting. This position will support the identification and development of databases to support business functions for the Medicare products, using enrollment, medical and pharmacy claims information. The Medicare Analyst analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, suggesting potential solutions, and helping Government Programs Product Management set strategic directions.
Accountabilities:
1. Identifies and documents current data flows for member enrollment attributes, such as HCC score, rate cell, care system, PCC (attributed site), care coordinator and other elements that support product management.
2. Investigates opportunities for expanded clinical data collection that are needed elements for HEDIS, CMS Stars, DHS Quality Initiatives.
3. Develops and modifies database to compile enrollment and clinical data for analysis and dissemination of information.
4. Performs complex analysis of the data. Researches, analyzes and interprets statistical data and provides technical assistance to other staff. Identifies issues to be researched, determining affected areas, estimating impact and leading the resolution.
5. Leads technical or process improvements to testing, analysis and research methods.
6. Independently manages the retrieval and analysis of data, and issues that may arise on multiple tasks or projects with limited management involvement.
7. Acts as a resource for other members of the department/division on business issues and may be responsible for training and guidance of other employees.
Qualifications
Required Qualifications:
- Bachelor's degree in related field, with 5 years related job experience, or 9 years job related experience in lieu of a degree.
- 2 years experience using various statistical software and computer programming (e.g., SAS, Visual Basic, DB2, Oracle, etc.) - Or - Requires advanced understanding/experience with multiple programming languages, systems, systems design and/or software development methodologies.
- Proficiency in Microsoft software applications such as Word, PowerPoint, Excel, Access.
- Ability to perform validation techniques, as well as perform and interpret a variety of statistical analyses.
- Demonstrated ability to design, evaluate and interpret complex data sets.
- Demonstrated ability to handle multiple tasks with competing priorities.
- Demonstrated analytic and problem solving skills.
- Excellent written and verbal communication skills and with an ability to interpret and communicate analytical information to both individuals and groups in a clear and concise manner.
- Demonstrated ability to present complex technical information to non-technical audiences and to senior decision-makers.
- Demonstrated ability to work effectively both independently and in a team setting with individuals having diverse professional backgrounds including business, technical and/or clinical.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job