Facilitate and develop the patient segmentation profiles, performance metrics and financial reporting functions needed to establish an enterprise-wide perspective for planning, deployment and tracking new population health initiatives. Alternate payment model tracking,for internal cost savings (ICS) for acute episodes of care with modeling of Total Cost Of Care (TCOC) for selected including the post-acute, pharmacologic, DME, spectrum. Provide analytics and decision support to current state business with development of transitional projections and scenario planning for population management pricing, ROIs, including internal cost of care review at the campus and enterprise-wide level. Ensures the provision of accurate and timely financial/Care Management reports and analyses to leadership, project sponsors and governance and for reconciliation with the consultant groups; Camden, Milliman, and the Centers for Medicare and Medicaid (CMS). Monitors the adequacy of cost capture- procedures in assessment of new and expanded episodes of care and recommends planning to support the identified impact. Acts as principal liaison with finance and decision support teams with respect to Population Health Integration projects. Reviews enterprise-wide data to assess risk in financial areas including total cost, quality, and engagement. Will assist in defined registry reporting & care gaps. Performs special projects and analyses as directed by project sponsors.
Principal Duties and Responsibilities:
Ability to manage a large set of data (some are raw flat file data), create models from scratch to review data, generate concise reports, interpret results from analysis / reports and make actionable recommendations to non-financial / non-technical audience.
Ability to complete work independently and collaborate with internal and external team members and participate in ACO and/or related meetings, committees or functions.
Ability to evaluate and utilize latest software tools/programs to manage complex and large data to generate trend analysis, statistical process control, standard dashboard / reports.
Able to design and implement dashboard reports according to business requirements and technical specifications including generate charts and graphs.
Excellent interpersonal communication (one-on-one and group) and customer service with ability to work both independently and as part of a team.
Strong analytical skills, with a proven ability to develop and document resolution of complex issues and examine irregularities in data.
Extremely organized, self-motivated individual able to handle fluctuating volumes of work, able to prioritize work to meet deadlines. This includes estimation of effort, time management and develop realistic timelines for projects and tasks.
Ability to automate / enhance processes using technical skills.
Ability to read, analyze, and interpret common scientific and technical journals, financial reports, legal documents, and a variety of instructions furnished in written, oral, diagram, or schedule form.
Prospective care redesign monitoring for efficiency, clinical outcome and engagement
Develop predictive model for defined populations and programs for cost and outcome
Develop recommendations and facilitate system-wide view for care management processes and outcomes
Develop models for patient segmentation to support precision in clinical intervention planning.
5 years’ experience in healthcare finance, Population Health, ACO, Health Plan, medical management/cost of care or decision support environment.
Proven quantitative and analytical skills.Experienced in the development of financial analysis, reporting, predictive analytics and claims systems.
Extensive systems knowledge, including PC spreadsheet design (Excel, Access), software packages and word processing and predictive modeling
Strong verbal and written communication skills. Ability to interact effectively and appropriately with a diverse group of co-workers and physicians.
Self-motivation, professionalism and good judgment required
Superior problem-solving capabilities.
Education: MA/MS degree in Computational Science or Economics.