Manager, Clinical & Business Insight

About the role

This role manages healthcare data reporting, querying, and analysis for the Data Management department with direct responsibility for healthcare utilization and cost analysis. Oversees a team of Clinical Analysts and Business Intelligence Analysts tasked with providing TriWest leadership with insights from clinical, operational, and performance data.

Responsibilities

• Act as an internal consultant to work across key stakeholders to gather data, perform analysis, and provide recommendations and insights to business leaders.
• Utilize coding methods and guidelines (CPT, ICD, HCPCS, POS, DRG, Revenue) to conduct clinical analysis and facilitate improved health outcomes.
• Execute business reporting functions, metric creation and reports that demonstrably drive operational actions and highlight wins / opportunities.
• Interpret claim data using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining.
• Drive improvements in cost efficiency, quality of clinical care, and effectiveness of clinical programs by performing data analysis to deliver actionable insights that are backed by empirical evidence.
• Develop optimization analysis to determine how well TriWest's network meets the needs of the Government based on authorization/claims patterns, discounts achieved and access to care requirements.
• Collect, compile, and analyze healthcare cost and discount trends, and identify opportunities for improving/maintaining discounts based on utilization patterns.
• Collaborate with others in Data Management and IT to enhance the data warehouse to include translating technical and functional requirements into meaningful information and improve healthcare reporting capability.
• Train department staff on healthcare data querying, terminology, integrity, standards, and procedures.
• Coach and mentor staff toward operational excellence and skill development.
• Work with management to understand and interpret the impact of decisions made by retrieving and analyzing claims costs, authorizations and/or other relevant data.
• Work closely with various groups in the assembling of data, development and application of quantitative analysis and mathematical models for internal and regulatory reporting requirements.
• Support Government reporting requirements, management and the medical management system by managing automated reports.
• Determine the best approach for presenting data in an efficient and beneficial manner.
• Prepare annual performance evaluations and development plans for assigned staff.

Requirements

Education & Experience Required:

• Bachelor's degree in Business Administration, Healthcare, Statistics, Information Management, CIS or related field or equivalent experience
• 5+ years of data analysis and reporting experience in the health care or insurance industry
• 3+ years experience leading/managing reporting and analytics teams
• Advanced knowledge of Business Intelligence tools (e.g. Tableau, SSRS)
• Excellent verbal and written communication skills and an ability to synthesize and present results in a clear and concise manner
• Demonstrated proficiency in the use of computer systems, spreadsheet applications, and data analysis software such as SQL query language, MS Excel and MS Access

Preferred:

• Familiar with coding methods and guidelines (CPT, ICD, HCPCS, POS, DRG, Revenue)
• 3+ years working with medical, pharmacy and ancillary claims data, membership data or other healthcare data
• 3+ years developing clinical measures and analyzing healthcare outcomes
• 1 year of experience with advanced analytics tools (e.g. SAS, SPSS, R)
• Masters degree in Business Administration, Statistics, Public Health or other applicable discipline

Qualifications

Required:

• US Citizenship
• Experience with VA healthcare, military health services system, and private Managed Care programs

Skills

• Strong knowledge of Microsoft Excel, Access
• Preferred strong knowledge of Crystal Reports, SQL Reporting Services, and other query software
• Knowledge of relational databases
• Working knowledge of medical management systems
• Working knowledge of referral and authorization systems
• Working knowledge of healthcare
• Working knowledge of medical coding, HIPAA regulations, claims processing, and healthcare reimbursement systems

Benefits

TriWest Healthcare Alliance offers a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

The salary range for this position is approximately $125,000 - $134,000 per year.

Company Overview

We're On a Mission to Serve®! Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.

TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more.

We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply.

Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.