- Develops and maintains data sets to enable advanced reporting on several aspects of value-based care performance related to CCHCACO covered lives, including cost and utilization, quality, and ambulatory care management.
- Supports CCHCACO case management, quality, payer enrollment and risk coding teams with performance reports and actionable insights, including provider-level reports.
- Maintains department operational and performance dashboards and related supporting documentation.
- Identifies and reports on trends or patterns within administrative claims or EMR data sets; performs risk stratification analysis identifying illness burden and high-risk patients.
- Extracts, transforms and loads administrative claims and electronic medical record (“EMR”) data via flat file or query via application programming interface (“API”)
- Utilizes CCHC Epic and other EMRs (e.g., Athena, eClinicalWorks) to extract information relevant to analyses and validate EMR data findings.
- Supports clinical data exchange with payers and in support of contract performance or maintenance of the provider network.
- Assist CCHCACO and CCHC leadership with development of analyses of contract proposals, fee schedules, charge-master changes and contract performance for CCHCACO and CCHC.
- Utilizes good data governance standards when bringing together differing data sets by documenting assumptions, sources, methods and validating control totals.
- In coordination with ACO staff, analyze data to view population health trends and patterns; identify individual health risks and high-risk populations; find opportunities to improve care at the population and individual level.
- In coordination with ACO staff, develops credible metrics and internal/external benchmarks in order to measure ACO performance against “goal.”
- Minimum of Bachelor’s degree or equivalent combination of education and experience to meet the needs of the position.
- 5 years of experience in healthcare informatics, managed care analytics or a related healthcare field.
- Knowledge of and experience with SQL, reporting systems, relational databases and healthcare information systems required.
- Epic experience is strongly preferred.
- Experience with CMS claim and claim line feed files (CCLF) and data visualization software is preferred.
- Microsoft Excel experience required; experience with Microsoft or other reporting platforms preferred.
- Knowledge of industry standard coding, such as ICD-10, DRG, CPT, HCPCS, and revenue codes.
- Ability to learn and master new information systems.
- Ability to effectively prioritize multiple demands and quickly absorb new ideas and concepts.
- Ability to present concepts and analytical results in a logical and concise manner.
- Ability to work both independently and as part of a team.
- Maintain information in a confidential manner in acceptance with policy.
Purpose of Position
Develops metrics and reports in support of Cape Cod Healthcare Accountable Care Organization (“CCHCACO”) value-based contracting and population health initiatives.
Schedule Details
Full Time, Mon-Fri, 9a-5p
Organization
Cape Cod Healthcare, Inc.
Primary Location
Massachusetts-Hyannis
Department
HCI-PO - PHO