Population Health BA
Description
Consultant Technical Analyst - Population Health and Care Management
Job Summary:
o Must demonstrate strong domain expertise, particularly in the
Payor-Provider ecosystem, with a solid understanding of Medicare,
Medicaid, and other relevant healthcare programs
o Works with stakeholders to discover, clarify, and document current and
future data needs
o Performs mapping of Population Health and Care Management data to
a normalized data model.
o Serves as a subject matter expert on the Population health data
domains such as Care Management, Utilization Management, Quality
Scores, HEDIS, Care gaps
o Builds data concepts to support Population Health use cases
o Serves as a key resource for an assigned customer area to understand
and explain business and technical issues and to provide viable
technology solutions.
Responsibilities:
○ Act as a quality consultant and subject matter expert, performing
testing and validation of the mapping of data elements to standards
○ Collaborates with technical resources to perform root cause analysis
and complete remediation of data quality issues
○ Works with customers to clarify and plan for their current and future
technology needs. Determines and maps existing business
processes/functions and recommends changes required to fit a tightly
integrated system.
○ Designs and implements projects requiring systems integration, small
teams and multiple technical platforms.
○ Conducts Return on Investment (ROI) and other financial analysis to
support project funding/prioritization.
○ Collaborates on driving improvement activities to achieve department
and organizational goals.
○ Coordinates with functional team to assure consistency and
optimization of overall work product
○ Assumes a proactive role in driving improvement activities to achieve
department and organizational goals to deliver value.
○ Maintains current knowledge of industry and business process trends
and is able to apply that knowledge to existing business processes.
○ Provides subject-matter expertise of Health Ministry processes, policies
and requirements in support of functional area process design, testing
and implementation
○ Identifies opportunities for process improvement and makes
recommendations that lead to improvements
o Must demonstrate strong domain expertise, particularly in the
Payor-Provider ecosystem, with a solid understanding of Medicare,
Medicaid, and other relevant healthcare programs
o Works with stakeholders to discover, clarify, and document current and
future data needs
o Performs mapping of Population Health and Care Management data to
a normalized data model.
o Serves as a subject matter expert on the Population health data
domains such as Care Management, Utilization Management, Quality
Scores, HEDIS, Care gaps
o Builds data concepts to support Population Health use cases
o Serves as a key resource for an assigned customer area to understand
and explain business and technical issues and to provide viable
technology solutions.
Responsibilities:
○ Act as a quality consultant and subject matter expert, performing
testing and validation of the mapping of data elements to standards
○ Collaborates with technical resources to perform root cause analysis
and complete remediation of data quality issues
○ Works with customers to clarify and plan for their current and future
technology needs. Determines and maps existing business
processes/functions and recommends changes required to fit a tightly
integrated system.
○ Designs and implements projects requiring systems integration, small
teams and multiple technical platforms.
○ Conducts Return on Investment (ROI) and other financial analysis to
support project funding/prioritization.
○ Collaborates on driving improvement activities to achieve department
and organizational goals.
○ Coordinates with functional team to assure consistency and
optimization of overall work product
○ Assumes a proactive role in driving improvement activities to achieve
department and organizational goals to deliver value.
○ Maintains current knowledge of industry and business process trends
and is able to apply that knowledge to existing business processes.
○ Provides subject-matter expertise of Health Ministry processes, policies
and requirements in support of functional area process design, testing
and implementation
○ Identifies opportunities for process improvement and makes
recommendations that lead to improvements
○ Monitors task assignments to ensure they are performed on schedule,
within intended scope and to a defined level of quality.
○ Escalates process and project issues that cannot be resolved
Experience:
○ Prior experience working as a Population Health analyst in the
Healthcare system.
○ Must have a working knowledge of relational databases/database
structures, SQL expertise desired
○ Must have a strong understanding of data collected and used in
Claims, Adjudications, Health Insurance and Care and Utilization
Management
○ Knowledge and experience with ambulatory and acute clinical, billing
and claims workflows and clinical information systems.
○ Bachelor or Masters degree in related health or finance field ex
informatics or bioinformatics.
○ Complexity of work: Within the scope of job, requires critical thinking
skills, decisive judgment and the ability to work with minimal
supervision. Must be able to work in a stressful environment.
○ 5 years of experience preferred
within intended scope and to a defined level of quality.
○ Escalates process and project issues that cannot be resolved
Experience:
○ Prior experience working as a Population Health analyst in the
Healthcare system.
○ Must have a working knowledge of relational databases/database
structures, SQL expertise desired
○ Must have a strong understanding of data collected and used in
Claims, Adjudications, Health Insurance and Care and Utilization
Management
○ Knowledge and experience with ambulatory and acute clinical, billing
and claims workflows and clinical information systems.
○ Bachelor or Masters degree in related health or finance field ex
informatics or bioinformatics.
○ Complexity of work: Within the scope of job, requires critical thinking
skills, decisive judgment and the ability to work with minimal
supervision. Must be able to work in a stressful environment.
○ 5 years of experience preferred