Healthcare Business Analyst I - 152827
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.
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:
- Provide internal ad-hoc reports in a manner that is accurate, timely and consistent.
- Utilize geographic information system tools (e.g. ArcGIS, Quest Analytics) to perform network adequacy and spatial analyses.
- Create and maintain tabular models using SQL Server Analysis Services to facilitate enterprise reporting.
- Perform statistical analyses to develop recommendations to business owners that improve workflows, processes, and compliance.
- Utilize statistical models (CDPS, CMS Risk Adjustment, 3M) to identify trends in utilization and performance over time.
- Review, analyze, and evaluate financial, medical, and member data to determine trends, issues, or opportunities for improvement.
- Maintain compliance with the production of all State of Texas deliverables or other governing body in a timely manner.
- Develop automated reports and schedule subscriptions using SQL Server Reporting Services and Microsoft Power BI.
- 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).
- Two years of experience developing actionable reporting using key metrics communicated in an easy to understand manner.
- Two years of experience with reporting tools (e.g., MS Excel, Access, SQL Reporting Services, Power BI or similar tool).
- Bachelor's degree in Computer Science, Healthcare Administration or related field.
- Knowledge of healthcare coding, (ICD, CPT, DRG).
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.