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Health Data Analyst - Remote
Company | Teacher Retirement System of Texas |
Address | , Austin, 78701, Tx |
Employment type | FULL_TIME |
Salary | |
Expires | 2023-06-18 |
Posted at | 1 year ago |
WHO WE ARE:
With the Health & Insurance Benefits Division, you’ll be joining a passionate team of self-motivated change agents united by our mission: driving to design the delivery of high-quality healthcare for nearly three-quarters of a million active and retired Texas public educators. The healthcare industry is complex
and we’re a team of problem-solvers who are up for the challenge. With a focus on innovation and collaboration to catalyze the market, we spend nearly $4 billion annually on healthcare to make a difference in our members’ lives. With a career at TRS, you’ll be empowered through a culture of
continuous learning, front-line decision making, coaching and mentorship to shape the future of our work, while transforming healthcare delivery for 1 in 41 Texans.
The Health Data Analyst performs complex data analysis and research on health care claims data and participates in contract administration and vendor procurement activities. Work involves developing data queries and analyzing health care data to assess the health plan performance; overseeing the work of vendors supporting the health plans; and supporting the procurement and contracting of health care and related services. Works under limited supervision with considerable latitude for initiative and independent judgement. This position will proactively work with HIB staff, agency employees, and health care vendors.
This a primarily remote position that will require the selected applicant to report to the TRS offices, located in Austin, TX, 1-2 times per quarter or as needed to meet business needs. All applicants must reside in the state of Texas upon employment and continue to reside in Texas throughout employment with TRS.
This vacancy will be filled at one of two levels - Health Data Analyst or Senior Health Data Analyst. Selected applicant will be offered the position that most closely matches their education and experience.
Salary Range
Health Data Analyst: $66,930 – $83,662
Senior Health Data Analyst: $80,985 – $101,231
WHAT YOU WILL DO:
Research and Data Analysis
- Develops and automates queries in TRS’ data warehouse to extract data for use in spreadsheets, models, dashboards, and summaries that support decision-making.
- Reviews and validates reports on health plan performance.
- Identify enrollment and cost trends, cost-saving opportunities, and potential fraud, waste, and abuse.
- Analyzes detailed enrollment, claim, utilization and other health care related data to identify trends and anomalies, and to identify areas of action.
- Analyzes claim data to support invoice processing. (Senior)
- Reviews and reports on health care claims, participant service utilization, and pricing to assist with HIB management decisions.
- Analyze provider reimbursement levels, high cost claims, costs by geographic area and place of service, and claim accuracy.
- Facilitates the interpretation of health care data from external sources including data from TRS' health care consultants, insurance companies, or other industry resources.
- Reconciles financial performance guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs. (Senior)
Health Care Services Procurement & Contract Management
- Reviews and analyzes various routine vendor reports on a monthly, quarterly, and annual basis.
- Assists with the evaluation of bidder proposals with respect to operational capabilities and financial terms.
- Assists with evaluating HIB’s business needs related to plan performance and vendor services.
- Communicates regularly with vendors to address business needs and service issues.
- Assists with the development of procurement documents, such as statements of work and evaluation criteria.
- Negotiates business and financial terms of contracts with vendors and finalizes contract documents. (Senior)
- Works with vendors and external partners to carry out research related to the administration of TRS health plans.
- Works with TRS' legal and purchasing departments in the renewal of contracts and amendments.
Program Administration
- Researches, recommends, and implements methodologies for reporting health care data and statistics including key performance indicators for program activities.
- Regularly communicates with vendors related to plan performance and initiatives, claims and utilization, provider network updates, pharmaceutical changes, marketplace situations and trends.
- Coordinates and oversees internal and external audits of contractors and resolves audit findings. (Senior)
- Assists with the reconciliation of financial performance guarantees relating to medical loss ratios, claim trends, pharmacy rebates and discounts, and ROIs.
- Review claim and enrollment data to provide support for invoice processing and benefit decision-making.
- Supports other areas of HIB in analyzing program data and developing key performance indicators and dashboards as needed.
- Addresses and resolves non-compliance or subpar performance issues with contractors. (Senior)
- Monitor vendor performance in areas of cost trends, service/process quality and delivery, implementation of plan initiatives, and contract compliance.
- Participates on special projects, task forces, and committees as needed.
Performs related work as assigned.
Required Education
- Advanced degree in actuary science, accounting, finance, mathematics, statistics, business, health care, health care administration, or closely related field may substitute for one year of the required
- High school diploma or equivalent and additional health care industry, benefits and/or health insurance claims processing, research, data and/or financial analysis, accounting, auditing or other directly related experience may substitute for the required education on a year-for-year basis.
- Bachelor’s degree from an accredited college or university in accounting, finance, mathematics, statistics, business, health care administration, or a closely related field.
Required Experience
- Three (3) years of full-time experience in analyzing health care claims data or administration of a health insurance plan. (Health Data Analyst)
- Five (5) years of full-time experience in analyzing health care claims data or administration of a health insurance plan (Senior Health Data Analyst)
Preferred Qualifications
- Recent experience in health plan consulting, actuarial services, business finance, accounting, or auditing.
- Advanced degree in actuary science, finance, mathematics, statistics, business, health care administration, or closely related field.
- Self-funded and fully insured group health benefit products and contracts, including Medicare Advantage.
- Health care related laws, regulations, policies and procedures.
- Health care claims data including CPT, HCPCS, DRG, ICD-10, and NDC.
- Provider networks, contracts, plan operations and system
- Data analysis concepts and methods, including education equivalent to at least statistics for business, health benefit claims processing, Medicare, coordination of benefits, standard medical procedures, and billing.
- Writing programming code to process data including SQL and other tools such as R or Python.
- Researching, compiling and analyzing complex data, including querying a claim data warehouse.
- Completing detailed work with a high degree of accuracy.
- Interpreting and applying complex laws, regulations, policies, and procedures.
- Managing projects, including planning, organizing, and prioritizing work assignments to manage a high-volume workload in a fast-paced and changing environment.
Military Occupational Specialty (MOS) Codes:
Veterans, Reservists or Guardsmen with experience in the Military Occupational Specialty ( http://www.hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_AdministrativeSupport.pdf ) along with the minimum qualifications listed above may meet the minimum requirements and are highly encouraged to apply. Please contact Talent Acquisition at [email protected] with questions or for additional information.
To view all job vacancies, visit www.trs.texas.gov/careers or www.trs.csod.com/careersite.
For more information, visit www.trs.texas.gov.
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