BlueCross BlueShield of Western New York

About BlueCross BlueShield of Western New York

 

Job Category:

Healthcare/Pharmacy

Country:

United States

Postal Code:

14201

Approximate Salary:

Not Specified

Position Type:

Full Time

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Clinical Analyst II

Posted: 09/17/2018

Auto req ID 1979BR Company HealthNow NY, Inc. About Us BlueCross BlueShield of Western New York is a division of HealthNow New York Inc., one of New York’s leading health care companies that provides access to quality health care and solutions for members throughout Upstate New York. Since 1936, BlueCross BlueShield has helped millions of people gain access to health care. Headquartered in Buffalo, NY, the company is an independent Licensee of the BlueCross BlueShield Association. As the region’s leading health plan, serving over 800,000 members, BlueCross BlueShield believes in taking small steps towards healthier living. You can visit our website at www.bcbswny.com. Title Clinical Analyst II Position Posting Location Buffalo Status Full Time Regular Hours As required Job Description The Clinical Analyst II provides value-added analysis of population healthcare data. The incumbent demonstrates business and data understanding; provides advanced comprehensive reporting of healthcare data, statistical analysis, including predictive analytics, data manipulation, interpretation, presentation, and recommendations on specific courses of action. The analyst is also responsible for research and analysis of clinical and financial data to identify opportunities and improve medical policies within Healthcare Services and Account Management departments. Primary Responsibility - Creates and maintains detailed monthly performance reporting for Healthcare Services and Account Management departments to identify potential cost drivers and negative trends at the service and/or pharmacy level and makes appropriate recommendations to senior management to support all financial and operational objectives
- Envisions, develops and creates ad hoc financial analysis/ reporting as requested or to further support recommendations
- Uses insight and business aptitude to bridge finance and health analytics and suggest the development of new reports to enhance available information/reporting on an ongoing basis
- Identifies and reengineers the process to automate reporting solutions to eliminate redundancy.
- Designs and develops utilization management, case and disease management dashboards/models and reports to support on-going operations of Healthcare Services department and to evaluate population health management programs
- Provides comprehensive analysis of account/group/provider performance through an in-depth knowledge of benefit design, trend analysis, utilization impacts to trend, and clinical drivers of cost and utilization
- Creates accurate and meaningful reports and acts in a consultative capacity to articulate complex clinical data or trends in meaningful, understandable presentations or report formats for all internal and external customers
- Coaches, counsels and assists internal and external customers on the use of available reporting tools
- Participates on various teams and attends meetings (with, or in lieu of, Manager or Director of Clinical Analytics) needing financial analysis of various courses of action, and keeps Senior Management apprised of such activities as it directly impacts organizational performance
- Performs other related duties as required
Knowledge and Skills - Systems/Software Proficiency: MS Word, MS PowerPoint – intermediate, MS Excel – Advanced; MS SQL – Intermediate; SAS/R/Python –Intermediate
- Ability to manage full cycle analytical/reporting solution from requirements gathering to data modeling and report authoring
- Understanding of relational database concepts
- Familiarity with healthcare reimbursement systems and methodologies
- Knowledge and understanding of benefit structures and provider arrangements
- Familiarity with health claims grouping methodologies (MEGs, ETGs, DRGs, etc.)
- Strategic thinking/planning skills
- Public presentation skills
- Excellent organizational skills and attention to detail
- Excellent verbal and written communication skills
- High comfort level conveying ideas to senior level management
- Ability to work effectively with minor supervision
- High degree of business maturity and demonstrated confidentiality
- Persuasive communication style
- Polished, professional image and reputation
- Demonstrated personal accountability
Experience - 5-7 years work experience in a Healthcare environment/health insurance industry required
- 3-5 years work experience in an analyst capacity required
Education - Required Education:

- Bachelors Degree in Business Administration, Economics, Healthcare Administration, Nursing, or related area of study required
Working Conditions - Must be able to work in an office environment
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
- Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc.)
EEO Statement All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status. Removal Date 17-Sep-2019

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