Healthcare Data Analyst
Title: Healthcare Data Analyst
Location: United States
About Pulse8, Inc.
- Pulse8 is an innovative Healthcare Analytics and Technology Company that delivers visibility and transparency for Risk Adjustment and Quality Management programs.
- We enable health plans and at-risk providers to achieve the greatest financial impact in the Health Insurance Exchange (HIX), Medicare Advantage, and Medicaid markets.
- By combining advanced analytic methodologies with extensive health plan experience,
- Pulse8 has developed a suite of uniquely pragmatic solutions that are revolutionizing risk adjustment.
- Pulse8’s flexible business intelligence tools offer real-time visibility into member and provider activities so our clients can apply the most cost-effective and appropriate interventions for closing gaps in documentation, coding, and quality.
What’s cool about working for Pulse8?
- We’re a close-knit team of Healthcare and Technology experts dedicated to helping people live longer, healthier lives.
- You’ll get to help us design and build innovative solutions from the ground up and have the opportunity to do lots of interesting things in an entrepreneurial culture. We offer competitive benefits and much, much more!
- Healthcare Data Analyst will assist our organization as a subject-matter-expert in Medicare Advantage and/or Affordable Care Act (ACA) Risk Adjustment by leading business cases for algorithm development and improvement, researching customer queries of analytics performance, and creating requirements for new analytics and data products.
This is a remote position.
- Developing business cases and requirements for Risk Adjustment analytics such as condition gap opportunities, Risk Score modeling, and financial impacts and trending.
- Leading customer requests for in-depth research and analysis.
- Owning customer financial improvement modeling and engaging directly with current or new customers to update models.
- Leading research initiatives to monitor Pulse8’s algorithm performance over time and recommend future enhancements.
- Collaborating with Pulse8 clinicians in outcomes, algorithm performance, and new product development.
- Developing customer presentations and reporting enhancements to streamline Pulse8 operations and support processes.
- Providing training and guidance to customers and other teams on all facets of the Risk Adjustment process, from initial data capture at point-of-care, through acceptance to CMS, and successfully validated through audit.
- Researching government regulatory guidance, providing expert interpretation for impacts to Pulse8 products and customers.
Academic and Professional Qualifications:
- Bachelor’s degree in Actuarial Science, Math, Statistics, or in a related field of study
Minimum Essential Knowledge / Skills:
- 5 or more years of experience analyzing and interpreting MA/ACA Risk Adjustment data
- Experience supporting the development of scalable analytic and reporting solutions
- Extensive experience in healthcare industry, with a focus on Risk Adjustment
- Experience with MA/ACA Risk Scoring methodology, including familiarity with condition categories (HCC)
- Experience interacting with large amounts of healthcare data
- Experience working with clinical classification such as diagnoses (ICD), procedures (HCPCS, CPT) and claims processing
- Experience working with data to and from submission systems (RAPS, EDPS, Edge), including background on filtering logic for each system
- Experience with SQL or SAS
- Experience with MA mid-year and final year projections (MYRA, FYRA) and/or ACA transfer payments
- Working knowledge of statistics with ability/interest to become proficient
- Proven technical, analytical and problem solving
- Strong written and verbal communication
- Professional and interpersonal
- Self-initiative and leadership
- Ability to work within a team environment
- Ability to interface with both external and internal personnel at all levels.
- Will travel to Annapolis, MD for new hire orientation
- All Pulse 8 employees attend two company summits per year in various locations.