Job Description

PURPOSE OF POSITION:

Develops metrics and reports in support of Cape Cod Healthcare Accountable Care Organization (“CCHCACO”) value-based contracting and population health initiatives.

PRIMARY DUTIES AND RESPONSIBILITIES:

1. 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.
2. Supports CCHCACO case management, quality, payer enrollment and risk coding teams with performance reports and actionable insights, including provider-level reports.
3. Maintains department operational and performance dashboards and related supporting documentation.
4. 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.
5. Extracts, transforms and loads administrative claims and electronic medical record (“EMR”) data via flat file or query via application programming interface (“API”)
6. Utilizes CCHC Epic and other EMRs (e.g., Athena, eClinicalWorks) to extract information relevant to analyses and validate EMR data findings.
7. Supports clinical data exchange with payers and in support of contract performance or maintenance of the provider network.
8. Assist CCHCACO and CCHC leadership with development of analyses of contract proposals, fee schedules, charge-master changes and contract performance for CCHCACO and CCHC.
9. Utilizes good data governance standards when bringing together differing data sets by documenting assumptions, sources, methods and validating control totals.
10. 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.
11. In coordination with ACO staff, develops credible metrics and internal/external benchmarks in order to measure ACO performance against “goal.”

EDUCATION/EXPERIENCE/TRAINING :

• 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.

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