Senior Provider Analytics Consultant

Company :

Highmark Inc.

Job Description : 

***CANDIDATE MUST BE US Citizen (due to contractual/access requirements)***

JOB SUMMARY

The incumbent will serve as a Senior Provider Analytics Consultant (or chosen title) focused on critical data management, regulatory compliance, and automation within our provider functions. This role requires exceptional proficiency in data manipulation and analysis, specifically for code enhancement and Quality Assurance (QA) of regulatory reports. The incumbent must be adept with tools such as Excel, SAS, SQL, and Power BI, and will be instrumental in delivering testing plans for system and report enhancements. A key aspect of this position involves building and optimizing M365 tools to automate team workflows and enhance operational efficiency. Deep familiarity with CMS and state provider data requirements is essential, as is a heavy focus on understanding provider data within the Health Insurance Managed Care Organization (MCO) realm. Furthermore, strong knowledge of provider network management and network adequacy standards is required. This role delivers consistent high-quality analytics and insights to guide program design, acts as a subject matter expert on provider data, and proactively drives innovation and process improvement.

   

 

ESSENTIAL RESPONSIBILITIES

• Develops complex and innovative internal and external facing provider reports/analytic tools that clearly highlight key performance indicators for value based reimbursement programs and examine the major trend drivers of overall financial/quality performance; engineers reports to have self-service capability enabling customers to use the report and tools independently. Drives collaboration across several analytic groups to ensure reporting is comprehensive and accurate.
• Proactively designs complex scorecards and dashboards using advanced analytic tools to support value based reimbursement arrangements with large strategic partners in the market. Demonstrates expertise in how strategic partners use the reports and identifies opportunities to improve existing reports. Engages with key strategic partners to foster an understanding of reports, anticipate needs, and drive strategy around reporting/analytic tools.
• Supports the creation of the most impactful and broadest value based reimbursement programs across the enterprise, including initiatives for PCPs, specialists, facilities, post-acute providers, and ancillary providers. Proactively anticipates technical hurdles and leverages experience to drive positive outcomes. Consistently shares insights with lesser experienced staff members to help influence the best possible decisions.
• Interprets raw claims, provider, quality, and member data to build data sets for analytic and reporting purposes. Displays mastery of multiple programming and query tools and is a resource to less experienced teammates. Dedicates time to research and implement process improvement/automation of existing reports. Communicates best practices across the department.
• Leads provider cost savings analyses related to value based reimbursement and understands how return on investment impacts the enterprise and the provider. Generates ideas for potential cost-saving initiatives by utilizing experience of market dynamics and what has historically delivered outcomes and effectively communicates these concepts to stakeholders.
• Reports on financial outcomes of value based provider arrangements and provider incentives to accurately reflect financial position. Routinely identifies potential risks and opportunities and clearly defines scenarios for achieving certain outcomes.
• Enhances department influence by providing responsive service and expert consultation. Effectively and confidently presents information and provides decision support to team members and senior management. Ensures highly visible and effective communication channels are implemented to monitor sentiment, feedback, and acceptance of change. Anticipates a customer's needs and responds appropriately.
• Other duties as assigned or requested.

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​EXPERIENCE

Required

• 10 years of Relevant analytic work experience
   

Preferred

• 10 years Insurance or healthcare work experience

​SKILLS

• Analytic Judgement
• Highly Skilled in Analytic Tools & Technology
• Efficient and Organized Work Habits
• Intellectual Capacity and Curiosity
• Strong Work Ethic & Standards
• Core Financial Knowledge
• Customer Driven Communication
• Strong Initiative
• Strategic Thinking
• Project Management

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EDUCATION

Required

• Bachelors degree in Mathematics, Statistics, Finance & Accounting, Actuarial Science, Economics or related field or 6 years of relevant work experience in lieu of a Bachelor's Degree
   

  Preferred

• Master's degree in a technical field (e.g., Computer Science, Data Science, Information Systems), Health Informatics, or a related field.

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$102,700.00

Pay Range Maximum:

$164,600.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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