Responsibilities
This role will analyze and interpret Medicaid data to support decision-making processes, improve healthcare outcomes, ensure compliance with regulatory requirements, and streamline claims management data processing. Below are enhanced and specific responsibilities aligned with the team’s needs:
1. Data Collection and Management:
o Collect, clean, and manage large datasets from various sources including electronic health records (EHR), claims data, and other healthcare databases
o Ensure data integrity, accuracy, and completeness
2. Claims Management Data Processing:
o Analyze claims data to identify trends, patterns, and anomalies in Medicaid claims
o Develop and implement processes for claims data validation and reconciliation
o Collaborate with claims management teams to streamline data processing workflows and ensure timely and accurate claims adjudication
3. Data Analysis and Modeling:
o Conduct complex data analysis to identify trends, patterns, and insights related to Medicaid services and utilization
o Develop and implement analytical models using SQL, Databricks, and Python
o Utilize Azure and AWS for data storage, processing, and analysis
4. Reporting and Visualization:
o Create comprehensive reports, dashboards, and visualizations to communicate findings to stakeholders
o Use tools such as Tableau, Power BI, and RShiny to develop interactive visualizations
o Present data insights and recommendations to healthcare providers, administrators, and policymakers
5. Compliance and Quality Assurance:
o Ensure compliance with federal and state Medicaid regulations and reporting requirements
o Conduct quality assurance checks to ensure data accuracy and reliability
6. Collaboration and Support:
o Work closely with our client business teams, including IT, clinical staff, and management, to support data-driven decision-making
o Provide training and support to staff on data-related tools and processes
7. Continuous Improvement:
o Identify opportunities for process improvements and implement best practices in data analysis and management
o Stay updated with the latest trends and advancements in healthcare data analytics and Medicaid policies
8. Deliverables:
o Deliver data artifacts post-analysis on a monthly, weekly, and ad-hoc basis to our client business teams
o Ensure timely and accurate delivery of data insights and recommendations
Qualifications
• Excellent analytical and problem-solving skills
• Strong attention to detail and accuracy
• Ability to interpret complex data and present findings in a clear and concise manner
• Strong communication and interpersonal skills
• Ability to work independently as well as part of a team
• Ability to support data analysis projects, develop reports and dashboards, and assist in data cleaning and preparation
• Knowledge of healthcare data standards and privacy regulations (e.g., HIPAA)
Required:
• Bachelor’s degree in Data Science, Statistics, Public Health, Health Informatics, or a related field
• Minimum of 5 years of experience in data analysis, preferably in a healthcare or Medicaid environment
• Strong understanding of Medicaid policies, procedures, and regulations
• First-hand experience with SQL, Databricks, and Python
• Proficiency in 1 or more cloud platforms, such as, Azure and AWS
Preferred:
• Master’s degree in Data Science, Statistics, Public Health, Health Informatics, or a related field
• Experience with one or more: SAS, R, and RShiny