Data Analyst

GENERAL PURPOSE\ Provides analytic and technical support for the purpose of identifying fraud, waste, and abuse, supporting medical policy decisions, provider payment review, and other analytic needs as required. Supports the development of written materials for provider outreach and communications. Develops materials to support internal policies and procedures.\ \ ESSENTIAL DUTIES/RESPONSIBILITIES [Core 25d]

Establishes key payment integrity performance metrics.

Coordinates with vendors and provides oversight for submission of HEDIS data.

Analysis of various health care data with focus on delivery and quality of care.

Conducts research and analysis of health care utilization and presents findings to management.

As requested by management, develops reports and provides recommendations for various corporate initiatives.

Researches and analyzes health care code changes.

Special projects as assigned.

Works towards quality initiatives.

\ OTHER DUTIES/RESPONSIBILITIES\ Other duties as assigned.\ \ SUPERVISORY DUTIES\ None.\ \ JOB QUALIFICATIONS\ KNOWLEDGE, SKILL and ABILITY: [Core 25b]\ Strong organizational skills and attention to detail.\ Ability to conduct statistical analysis of health care data.\ Ability to make presentations about complex topics.\ Working knowledge of database query and design.\ General knowledge of CPT and ICD-10 procedure and diagnosis coding.\ Ability to obtain a working knowledge of professional and institutional reimbursement.\ Ability to understand the Wyoming health care environment.\ Effective communication and interpersonal relations skills.\ Computer skills including Windows, Microsoft Word, ACCESS, EXCEL, COGNOS, PowerPoint, SQL and Outlook.\ \ EDUCATION, LICENSURE, OR FORMAL TRAINING: [Core 25a and 25c]\ Bachelors degree (typically in math, statistics, business or healthcare). Commensurate experience may be considered in lieu of degree.\ \ EXPERIENCE: [Core 25a]\ Three to five years of relevant work experience (typically in health care finance or data analytics).\ \ MATERIAL AND EQUIPMENT DIRECTLY USED:\ Standard office equipment.\ \ WORKING ENVIRONMENT/PHYSICAL ACTIVITIES:\ Works in an open office environment. Physical activities include, but are not limited to, keyboard and calculator manipulation, carrying light weight objects short distances to other departments and telephone use.\ \ ACCESS TO PROTECTED HEALTH INFORMATION (PHI)\ Access to Protected Health Information (PHI) will be limited to that which is necessary to carry out job duties outlined above.