Healthcare Claims Data Analyst (ORS/CQCT)

Healthcare Claims Data Analyst (ORS/CQCT) 71091324 Do you have a passion for provides administrative and logistical support that includes arranging meetings and webinars, compiling, and circulating documents such as protocols and operations manuals, preparing presentations and Data Use Agreements? If so, this might be the position for you! About the division: The Health Care Authority’s mission is “Provide high quality health care through innovative health policies and purchasing strategies.” The Clinical Quality and Care Transformation (CQCT) Division has the purpose of designing and implementing clinical policy; conducting oversight and monitoring of all clinically related programs; and communicating with stakeholders, providers, plans, and delivery system partners on clinical activities and issues. The Data Team (DATA) of the Health Care Authority is responsible for leading the Washington State Health Information Technology (HIT) strategy; leading Data Governance strategy for the Agency; and leading the implementation, maintenance, and enhancement of the data management, analytics and reporting systems that inform Agency leadership in support of HCA’s purpose and goals, as well as for improving and monitoring agency and program performance to ensure accountability and alignment with all agency activities. About the position: The Healthcare Claims Data Analyst performs statistical data analysis and analytic projects in the specialized area of all-payer healthcare claims data and acts as the healthcare study data analyst within the WA-APCD program. This position develops and designs complex operations and research using statistical, data mining, analytical and visualization methods to investigate and answer complex healthcare issues using traditional and emerging data analysis techniques. The data, tools, presentations, and analyses generated by the position focus on original healthcare, policy and operations research and will be used for high profile, legislatively mandated initiatives, ad hoc data reports for multiple stakeholders, and internal policy and program decision-making. The position develops advanced analytics using agency approved enterprise data tools and programming languages and requires in-depth and specialized subject-matter expertise of medical, pharmacy, dental, eligibility and provider claims data. This position is comparable to a Program/Data Analyst position. This position is eligible to telework and is typically not required to report on-site. Travel may be occasionally required for meetings. Travel is primarily in state. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis. Some of what you will do: • Analyzes complex healthcare claims and associated healthcare service delivery data to respond to new, incoming, and complicated program and public reporting needs and requests. Actively uses SAS, R, SPSS and/or SQL languages and software applications to write data code/query scripts and independently develops complex quantitative and qualitative analyses to address these requirements. • Designs analysis and risk models for outcomes research, comparative analysis, patient stratification, and outlier monitoring and performs sophisticated data analyses and clearly demonstrates the relationships among claims variables, including the effect size and the statistical significance of the association. • Contributes to the development of new healthcare knowledge by developing and refining data analysis approaches in collaboration with colleagues across sister WA agencies and institutions supporting data-driven efforts to identify inefficiencies and irregularities in the provision of care. • Understands and applies medical coding (e.g., ICD-10) to analyze complex healthcare data from multiple sources; draws on experience in dealing with several coding systems and coding irregularities (e.g., defining episodes of care for a bundled payment reimbursement system). • Determines valid conclusions and develops appropriate recommendations and key insights and works collaboratively with partners and subject matter experts so that analysis results are presented in a comprehensible and interpretable manner appropriate to the audience (e.g., legislators, agency leadership, providers, etc.). • Actively engages and collaborates with HCA staff and other data teams to perform methodological peer review and works with stakeholders (e.g., agency management) to determine approach that supports program decisions and processes (e.g., WA-APCD public reporting priorities). • Participates in ongoing and new data validation efforts with the data vendor and various data submitters (private and public healthcare payers, including third-party administrators) by applying knowledge of claims validation methods and how claims data flow from providers to payers to the WA-APCD and barriers to the accuracy and completeness of these data. • Manipulates and packages complex data from the WA-APCD and other data sources using statistical, data mining, and analytical methods and design (e.g., data collection/extraction, data manipulation, data cleaning, analytical modeling, data warehousing, etc.). • Provides support and consultation to WA-APCD data requestors and data users (e.g., develops innovative and effective approaches to solve requestors analytics problems and communicates results and methodologies, assess statistical approach for suggested use case, judge data elements being requested against and privacy regulations and statutory requirements, etc.). • Develops and designs report templates and manages dissemination (e.g., development and posting of claims data reports on the HCA and WA-APCD program websites. • Creates and maintains a process for monitoring healthcare analyses and makes recommendations on data to be gathered for tracking and performance metrics for the program. Required qualifications: • A master’s degree from an accredited college or university in a STEM related field. AND • Three (3) years minimum experience of applying SQL, R, or SAS programming skills working with large and complex datasets, preferably healthcare data; A Ph.D. may substitute for two years of the desired experience. OR • A bachelor’s degree from an accredited college or university in a STEM related field. AND • Five (5) years of minimum experience of applying SQL, R, or SAS programming skills working with large and complex datasets, preferably healthcare data. OR • Nine (9) years of experience of applying SQL, R, or SAS programming skills working with large and complex datasets, preferably healthcare data. • Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy. • Demonstrated ability to identify, analyze, and interpret trends or patterns in complex datasets. • Ability to explain complex or technical information using plain language, ask clarifying questions, and clearly and concisely emphasize key points. • Ability to work in a fast-paced environment with tight deadlines and a high degree of political sensitivity. • Able to work independently and as part of a team. Preferred qualifications: • Able to lead a diverse group of employees towards a common goal. • Comfortable interacting with staff members at all levels of the agency. • High level of workload management including organization and prioritization of tasks. • Experience with federal and state processes, rule and HIPPA requirements. • Experience developing literature reviews, and/or environmental scans. • Prior experience analyzing healthcare claims data. • Advanced level SQL or SAS programming skills. • Advanced experience working with large and complex data sets. • Experience with data visualization using Tableau, Power BI, and other similar visualization tools. How to apply: Only candidates who reflect the minimum qualifications on their NEOGOV profile will be considered. Failure to follow the application instructions below may lead to disqualification. To apply for this position, you will need to complete your profile which includes three professional references and attach: • A cover letter that specifically addresses how you meet the qualifications for this position • Current resume To take advantage of veteran preference, please do the following: • Attach a copy of your DD214 (Member 4 long-form copy), NGB 22, or USDVA signed verification of service letter. • Please black out any PII (personally identifiable information) data such as social security numbers. Include your name as it appears on your application in careers.wa.gov. About HCA: The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents. HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost. What we have to offer: • Meaningful work with friendly co-workers who care about those we serve Voices of HCA • A clear agency mission that drives our work and is person-centered HCA's Mission, Vision & Values • A healthy work/life balance, including alternative/flexible schedules and mobile work options. • A great total compensation and benefit package WA State Government Benefits • A safe, pleasant workplace in a convenient location with restaurants, and shopping nearby. • Tuition reimbursement • And free parking! Notes: Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment. HCA is an equal opportunity employer. We value the importance of creating an environment in which all employees can feel respected, included, and empowered to bring unique ideas to the agency. HCA has five employee resource groups (ERGs). ERGs are voluntary, employee-led groups whose aim is to foster a diverse, inclusive workplace aligned with HCA’s mission. Our diversity and inclusion efforts include embracing different cultures, backgrounds and viewpoints while fostering growth and advancement in the workplace. Women, racial and ethnic minorities, persons of disability, persons over 40 years of age, disabled and Vietnam era veterans, as well as people of all sexual orientations and gender identities are encouraged to apply. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may contact Julie Laney at 360.725.5130 or [email protected]. The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply. Apply tot his job