AvMed Collaborative Care Network Provider Analyst: Details: SCOPE OF POSITION: The IDN Program Analyst shall be responsible for the collection and analysis of data, while maintaining data integrity across multiple functional areas of the program. A successful Analyst will be detail oriented, tenacious and possess strong healthcare financial reporting and analytical skills, which will provide ongoing evaluation of the program, and ensure critical quality metrics are monitored and met, resulting in optimum outcomes for members. ESSENTIAL JOB FUNCTIONS: • Responsible for the analysis of utilization, cost, physician practice and referral patterns across multiple medical expenses within the CCN program. Convert raw data into information useful for decision-making purposes and program evaluation. • Assist in the development and maintenance of a system of checks and balances to assure that the underlying data is consistent, complete, accurate, and provides value to the CCN across several functional areas of the organization. • Assist in the determination of new methods and processes for improving health data analysis within the CCN program. Implement and maintain company-wide standards for query structure and related data warehouse access procedures, ensuring baseline data consistency across functional lines. • Provide analytical support to key stakeholders of the CCN across several functional areas to ensure that all data analysis needs are met. • Retrieve, integrate and analyze medical and pharmaceutical claims data from multiple sources into seamless reporting packages designed to meet the needs of multiple users across functional areas of the CCN. • Work closely with AvMed and CCN committees to analyze data that identifies high volume providers, claims outliers and patients utilizing inappropriate care settings for additional review and opportunities for improvement. • Work closely with CCN staff to identify out-of-network provider utilization and alternative treatment settings as opportunities for cost reduction. • Establish minimum thresholds for claims and utilization that trigger clinical review, and develop escalation process. • Develop reports for trend comparisons of network costs, including provider claims, ALOS, and places of service. • Perform financial analysis of CCN reports by provider type, including physician, hospital, outpatient and free-standing facilities and all ancillary providers. • Conduct ongoing financial analysis and make recommendations for improvement to help ensure financial viability and optimal performance of the IDN program. • Develop formulas for calculating Shared Savings and determining overall program success for the calendar year. • Maintain thorough knowledge of AvMed systems and software. • Prepare report templates and discuss findings with providers. dlvr.it/7Q48Wg
Posted on: Tue, 04 Nov 2014 11:07:40 +0000
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