Senior Analytics Consultant - Regulatory Reporting Team (Remote Eligible)

Presbyterian Health Plan has provided insurance to New Mexico Medicaid recipients for many years. Serving our state and its residents in this manner is a responsibility that we take seriously and with pride.

 

As a key member of the Presbyterian Health Plan (PHP) Government Programs Informatics team, the Senior Analytics Consultant:

• Will directly support Clinical Operations, and need to understand Clinical Operations business processes, workflow and how it translates into reporting requirements.
• Will work on requirements that drive the Clinical Ops workflow and how it translates into reporting requirements.
• Understands how the workflow is implemented in Jiva and tracks/monitors changes in Jiva to understand impact to regulatory reports.
• Will work on coding complex Clinical Ops reports.

Our HSD regulatory reporting team directly helps our community! Presbyterian is the leader in Medicaid and Medicare in the state of New Mexico, representing 51% of the state program members.

 

The Team You'll Work With:
To ensure that all Managed Care Organizations support our Medicaid recipients as desired, New Mexico’s Human Services Department takes a data-driven approach with significant reporting requirements along with emergent ad hoc requests to respond to current needs. Our Government Informatics team was formed to build a scalable, sustainable process to support this intensive data-driven process.

In particular, the team:

• Delivers a large suite of reports in conjunction with business stakeholders across the health plan – automating to enable the delivery of over a hundred reports and data marts.
• Works closely with business stakeholders analyzing back end data and aligning with front end processes to create a representation of the data that accurately portrays the work that PHP is completing.
• Develops a thorough understanding of business processes to enable quality checks and responsive report updates as requirements change.
• Leverages Robotic Process Automation (RPA) to automate complex manual processes, reducing errors and increasing efficiency.
• Focuses on data engineering to improve data integrity across reporting through the use of data marts that normalize and standardize commonly used data.

Position Summary:

• Manage reporting/analytics/research solutions portfolios across the business units within the analytics organization.
• Perform advanced data research, management and analysis, prepare presentations to communicate results, and assist project leaders with development of solutions/tools.
• Serve as a subject matter expert in reporting/analytics area as needed driving all aspects of the initiative including identifying issues, forming hypotheses, planning and conducting interviews & analyses, synthesizing conclusions into recommendations and helping to implement the solution.
• Lead and manage several small to mid-size projects with cross functional teams as well as an individual contributor to implement, test and deploy the approved reporting/analytics solution in response to the business (clinical/operational/financial) needs.
• Responsible for mentoring consultants and analysts as well as creating and managing tactical work plan/ timelines for various reporting/analytics/research projects.
• Provide input to senior leadership in proactively identifying and forecasting future trends and needs in technology and analytical solutions from business stakeholders.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Position Details

• Full Time - Exempt
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Remote Eligible: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio

   

 

 

Preferred Qualifications

• Extensive experience in SQL, SAS and Payor side
• Clinical data experience
• Experience working with Medicaid/ Medicare claims
• Experience developing complex metric reports
• Experience performing QA for regulatory reports
• Experience driving business decisions and communicating with stakeholders

Minimum Qualifications

• Bachelors degree in a quantitative, business, or healthcare related subject. A Masters or a Ph.D. is highly preferred.
• Six (6) or more years of combined experience in business intelligence, reporting, analytics and health services research.
• Demonstrated project management skills as well as the ability to efficiently work and manage teams and resources.
• Experience working on complex analytical projects with diverse teams and developing data driven and outcome based initiatives to improve business decision making and operational efficiencies.
• Knowledge of health plan and delivery system operations, health care informatics, and healthcare benefits and terminology (e.g., care management).
• Understanding of operations in the Health Care industry and a strong acumen of business processes, including operations, delivery models and revenue models.
• Understanding of program evaluation life cycle, predictive modeling, data mining, and clinical best practices preferred.
• Experience in financial modeling, value analysis, and other financial management.
• Experience in health system finance, strategic planning or decision support analytics preferred.
• Content knowledge related to program outcomes evaluation, BI tools (e.g., BO), data visualizations tools (e.g., Tableau), statistical software such as SAS and Modeling techniques, as well as general health service research and outcomes reporting/analytics.
• Working knowledge of healthcare industry and healthcare information standards such as HL7, LOINC, FHIR, ICD 9/10 and CPT codes, industry standard groupers (e.g., ETGs, DRGs, DCGs, etc.) as well as of health care delivery system processes.
• Excellent written and oral communications.

 

 

 

• Consultation and Communication: Management competencies to collaborate, establish and sustain working relationships across the AO Hub/Spoke core teams assisting in development, implementation and management of reporting/analytics/research portfolio
  
  
• Oversee and support day-to-day consultation to business users and support management of cross-functional teams
  
  
• Manage reporting/analytics/research project portfolio with the vision & goals of specific Hub/Spoke core teams
  
  
• Manage business stakeholders communications to identify business needs and oversee creation of the use cases and user stories satisfying those needs
  
  
• Effective communication across the organization and at different levels, strategic thinking and actions to influence key stakeholders and business decisions
  
  
• Coordinate and deliver effective presentations/communique to communicate strategy and outcomes to business stakeholders

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

 

#LI-nonclinical

USD $69.72/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.