Value Based Program - Data & Reporting Lead

Remote US

Become a part of our caring community and help us put health first
 The Value Based Programs Lead generates ad hoc reports and regular datasets and/or report information for end-users using queries and scripts to inform value-based payment (VBP) model design and administration. The Data and Reporting Sr. Professional integrates data from multiple sources to produce requested or required data elements. Programs and maintains report forms and formats, information dashboards, data generators, canned reports and other end-user platforms. May create specifications for reports based on business requests. Collaborates with leaders to make decisions on complex issues regarding job duties and related tasks. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Key Responsibilities

  • Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
  • Scorecard creation and reconciliation of provider performance based on contractual terms.
  • Analyze utilization data to reconcile provider disputes.
  • Design and develop provider reporting packages to help providers understand their overall performance.
  • Partner with finance team to conduct impact analysis and modeling for new VBP models.
  • Collaborate with cross functional and matrixed teams to operationalize and rollout new VBP models.
  • Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
  • Design Return on Investment (ROI) Analyses for new Value Based Payments (VBP) using multiple data sources, including prior authorizations, healthcare claims, Admit/Discharge/Transfer (ADT) data, HEDIS data, etc.
  • Creation of data models to attribute members to providers for new value based programs and to evaluate program effectiveness
  • Ensure data integrity in program administration for new value based programs
  • Troubleshoot data integrity issues and offer solutions to solve challenges

Use your skills to make an impact

Required Qualifications

  • Bachelor's degree
  • Minimum 5 years of technical experience in data reporting having advanced Microsoft Excel skills including ability to link pivots to external data sources, creating pivot tables and summarizing data into reports and dashboards
  • Experience in Medicaid and/or Medicare managed care
  • Experience working with big and complex data sets within healthcare organizations
  • Progressed experience in SQL, SAS and other data systems
  • Proficiency in verbal and written communication to leadership
  • Strong organizational skills and ability to manage multiple or competing priorities
  • Strong analytical and problem solving skills
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Strong attention to …
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