Job Description

Job ID
149184
Location
CHC - Central Campus
Hiring Range:
Annual Minimum to Midpoint:
61000.00
-
73200.00
Full/Part Time
Full-Time
Regular/Temporary
Regular

About Us

Community Health Choice, Inc. (Community) is a non-profit Health Maintenance Organization (HMO) licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 70 hospitals, Community serves over 260,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Job Profile

The Healthcare Business Analyst I will utilize and evaluate claims, authorization, member and provider data to assist the manager of Analytics develop, track and monitor healthcare quality metrics, savings initiatives in revenue and cost and utilization trends and opportunities. Additionally, the Healthcare Business Analyst will:

  • Write queries, views, tables, stored procedures, and schedule jobs in SQL Server Management Studio based on user specifications using knowledge of healthcare coding (ICD, CPT, DRG).
  • Develop automated reports and schedule subscriptions using SQL Server Reporting Services and Microsoft Power BI.
  • Maintain compliance with the production of all State of Texas deliverables or other governing body in a timely manner.
  • Review, analyze, and evaluate financial, medical, and member data to determine trends, issues, or opportunities for improvement.
  • Utilize statistical models (CDPS, CMS Risk Adjustment, 3M) to identify trends in utilization and performance over time.
  • Perform statistical analyses to develop recommendations to business owners that improve workflows, processes, and compliance.
  • Create and maintain tabular models using SQL Server Analysis Services to facilitate enterprise reporting.
  • Utilize geographic information system tools (e.g. ArcGIS, Quest Analytics) to perform network adequacy and spatial analyses.
  • Provide internal ad-hoc reports in a manner that is accurate, timely and consistent.
  • Provide high level of internal and external customer satisfaction through cooperation with interdepartmental employees and external parties as a way to promote a professional work environment
  • Work collaboratively with coworkers to deliver member/provider services that meet or exceed member/provider expectations as evidenced by annual CHC Provider Satisfaction Survey and Member Satisfaction Survey scores of "Overall Satisfaction with CHC/Health Plan.
  • Provide internal ad-hoc reports in a manner that is accurate, timely and consistent.
  • Provide high level of internal and external customer satisfaction through cooperation with interdepartmental employees and external parties as a way to promote a professional work environment.
  • Educate departments on current business processes and their effects on reported measurements.
  • Actively contribute to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans.
  • Timely compliance with Departmental and Corporate Training Requirements/Opportunities.
  • Stay informed on latest Federal legislation and regulation (e.g. CMS, AHRQ, HHSC, etc.) guidelines that prescribe current, pending, and future metric discovery and reporting.
  • Participate in internal training to ensure reporting measurements and methodology can be understood and replaced, if needed, in an accurate manner.
  • Other duties as assigned.


Qualifications:

  • Bachelor's degree in Computer Science, Healthcare Administration or related field.
  • Two years of experience with SQL query writing.
  • Two years of experience with reporting tools (e.g., MS Excel, Access, SQL Reporting Services, Power BI or similar tool).
  • Two years of experience developing actionable reporting using key metrics communicated in an easy to understand manner.


OTHER SKILLS:
Above Average Verbal communication skills(Heavy Public Contact).
Writing/composing (Correspondence, Reports.

.

Benefits and EEOC

Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.

Community is an Equal Opportunity Employer.

Job Category

CHC IT

Application Instructions

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