Cambridge Health Alliance
Cambridge Health Alliance (CHA) is on a journey to transform its healthcare system into a high-performing, high-value Accountable Care Organization (ACO) with a patient Centered Medical Home model of care. The Senior ACO Analyst will be an integral part of the team and support global payment models for use in insurer and provider networks with complex risk sharing arrangements. This position will work collaboratively with other stakeholders, including finance, performance and medical management teams, physician and hospital organization, operations, and external entities.
This Senior Analyst role requires strong analytic, programming and organizational skills in order to extract, manipulate and interpret data, explain results, discover opportunities for improvement and create actionable business intelligence to support CHA goals.
Position Description - this position:
Provides research and support in the development of actuarially sound leading and trailing cost and utilization indicators and trends, quality incentive programs, and reimbursement methods and strategies for new contract negotiations with insurers, specialty services, tertiary providers and other continuum of care providers;
Retrieves, integrates, and analyzes data from multiple sources using SQL/SAS, advanced MS applications, and other BI tools; Maintains data integrity and initiates remediation steps if warranted; Focuses on harnessing financial and clinical data capabilities for improving analytics with the goal of creating actionable information for key stakeholders;
Supports data submission to external databases and performance measurement systems; Utilizes statistical, accounting and economics principles, and reporting tools to analyze, interpret, and develop presentations to communicate information in a clear and effective way;
Monitors risk contract payments and settlements, and execution and management of on-going contracts to ensure compliance with contractual provisions; Identifies and helps resolve issues in a timely manner; Manages implementation of new contracts;
Models medical expense reduction and panel management activities, risk adjustment analysis using grouper tools (such as DRGs, CPTs, DCGs, ETGs etc.) working collaboratively with physician organization, case management, finance, and operations areas;
Participates in annual budgeting and forecasting process and prepares reports of budget expenditures, revenues, and account/fund balances;
Works well both independently with minimal direction and in a team environment; Works collaboratively with cross-functional teams to achieve common department/CHA goals
Performs other duties as assigned
Serves as a subject matter expert as it relates to role
Education: Bachelor degree (Mater's preferred) in finance, mathematics, or a related quantitative discipline required.
Work experience: Minimum of five years with a bachelor's degree or three years with a master's degree in a healthcare, preferably managed care, setting
In-depth knowledge of financial and clinical data
Understanding of reimbursement methods and contracting strategies desired
Proficiency in using SQL/SAS and other BI tools to query databases
Proficiency in using other MS tools, including presentation software
Experience with Crystal reports and other reporting services preferred
Athena, Meditech and/or EPIC systems experience preferred
Ability to learn, implement, and administer new software packages