Healthcare Analyst Job Description

Healthcare Analyst Job Description

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Healthcare analyst provides analytics (the combination of predictive/descriptive models and tools that guide decision making) that support data-driven decision making for he Managed Care and IPA teams.

Healthcare Analyst Duties & Responsibilities

To write an effective healthcare analyst job description, begin by listing detailed duties, responsibilities and expectations. We have included healthcare analyst job description templates that you can modify and use.

Sample responsibilities for this position include:

Create and update monthly client dashboard cost and utilization reports
Be proactive in identifying utilization trends and researching claims processing issues
Track risk and path to risk providers and settlement information, review payments for rewards payments, and ensure accuracy of settlement calculations
Monitor performance of engaged and risk partners
Review quarterly settlement calculations
Understand buckets of membership, understand risk score budget and recon by plan, state and product
Identify ways to re-engineer current reports and process
Manage control between the platforms to assure data integrity
Possess developed skills and knowledge with focus on healthcare topic deliver original analysis and insights
Produce and maintain process for new client onboarding

Healthcare Analyst Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Healthcare Analyst

List any licenses or certifications required by the position: SAS, CCRC, CCRA, CCRP, CPA, CISM, CISA, AHIMA, CFA, CFE

Education for Healthcare Analyst

Typically a job would require a certain level of education.

Employers hiring for the healthcare analyst job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Economics, Statistics, Finance, Mathematics, Education, Epidemiology, Business, Accounting, Computer Science, Actuarial Science

Skills for Healthcare Analyst

Desired skills for healthcare analyst include:

Managed care and health care claims
Per Member Per Month and revenue
Utilization
Clinical and financial risk tracking
Competitive
Industry standards and practices in descriptive/predictive analytics and reporting concepts
State-of-the-art analytic and reporting services
Trend identification and predictive modeling exercises
Data visualization software

Desired experience for healthcare analyst includes:

Coordinate ad-hoc tasks via the Analytics Team workflow tool
Generate customized reporting based on clients’ needs and preferences
2-3 years of relevant experience (banking or research background preferred)
3-5 years of relevant experience, current buy side analyst preferred
Healthcare background preferred, healthcare services experience ideal
At least 1-2 years’ experience in research and/or consulting

Healthcare Analyst Examples

1

Healthcare Analyst Job Description

Job Description Example
Our growing company is hiring for a healthcare analyst. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for healthcare analyst
  • Extracts information from resources and translates information needed to form appropriate logic for rules
  • Completes reviews of medical policies and publications and its integration into the required database on a timely basis
  • Prepares documentation and reviews as needed with the Director
  • Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
  • Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations
  • Identify and monitor Key Performance Indicators (KPI)
  • Analyze healthcare trends/metrics and report results to upper management
  • Ad hoc projects and reporting as requested by management
  • Reporting includes running of ongoing reports assistance with ad hoc reporting
  • List specific engagement duties and responsibilities from contract, including GSA schedule, BPA/IDIQ and TO/DO
Qualifications for healthcare analyst
  • Minimum three years of experience with healthcare claims, billing, and/or coding directly for a hospital system, consulting firm, or major insurance company
  • Familiarity with financial concepts such as revenue, expenses, costs
  • Critical thinking skills and ability to solve problems
  • Exceptional command of written and spoken English, command of a second European language
  • 5+ years of experience with economic analysis, business case development, modeling, and simulation
  • Experience with Microsoft Excel, Access, and other data analysis tools at an expert level
2

Healthcare Analyst Job Description

Job Description Example
Our company is looking to fill the role of healthcare analyst. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for healthcare analyst
  • Maintain comprehensive knowledge of high-level functions within Collections ROPS
  • Research, analyze, present results, and recommend intelligent solutions to solve problems and address business challenges by applying a knowledge of data analysis, critical-thinking skills, and healthcare experience
  • Develop, implement and revise detail claims analysis
  • Will have training in HIPAA compliance and security requirements as it relates to healthcare data
  • Work with the appropriate client technical representatives, also coordinates tasks related to interface engine and application installation, development, and testing to validate that departmental data and transactions (from those ancillaries/departments that have their own systems) are received and interpreted correctly
  • Perform data collection, coding, and configuration activities for new interfaces
  • Test interfaces to validate that the required data is being passed correctly to external systems, and that incoming data is being parsed properly into existing systems
  • Coordinate application analysis, configuration, and testing activities with Client Analysts, as needed
  • Coordinate activities, issues, and escalation procedures with third-party vendors and other related persons, as needed
  • Develop policies and procedures related to interface management and documentation of interfaces, as needed
Qualifications for healthcare analyst
  • Desire to achieve service excellence, both internally and externally
  • Motivated, self-driven, open-minded, and team focused
  • Ability to travel to client location, both day trips and overnight travel
  • CPA, CFE, AHFI, RHIT or RHIA preferred
  • Investigative and/or interview skills a plus
  • Bachelor’s Degree in Finance or Real Estate preferred
3

Healthcare Analyst Job Description

Job Description Example
Our company is growing rapidly and is looking for a healthcare analyst. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for healthcare analyst
  • Act as a change agent with key sponsors to facilitate the dissemination of our work (e.g., developing deep understanding of our research findings, help translate these into practical solutions, facilitate change management)
  • Interviewing and collaborating with healthcare leaders in nursing, quality, and process improvement roles to gain, synthesize, and publish best practice content based on the insights gleaned
  • Sourcing and analyzing research and writing compelling content for publication in journals and reports to meet weekly, monthly and quarterly deadlines
  • Researching, monitoring, and reporting on broader developments across the healthcare industry for a clinical audience
  • Answering questions and special requests from hospital leaders through customized primary and secondary research and analysis
  • Creates project documentation which may include Business Requirements Documents, AS-IS and TO-BE Process Flow and Data Flow diagrams, Solution Design Specifications, Test Plans, and Test Cases
  • Deliver transparency into performance via monthly reports
  • A personality that enjoys intellectual challenges, and are able to think of innovative solutions to achieve goals
  • A strong team player, flexible and able to work in a fast-paced team structure
  • A strong interest in the healthcare industry
Qualifications for healthcare analyst
  • 2 to 4 years experience in management consulting or investment banking at a top-tier institution
  • Ideally experience of or high level of interest in the Healthcare Industry
  • Outstanding structured, problem-solving capabilities
  • Ability to work effectively in a collaborative team environment, independently
  • Strong communication skills and an ability to deal with individuals from a variety of backgrounds, including senior management
  • Ability to carry out responsibilities accurately and independently, work effectively within teams
4

Healthcare Analyst Job Description

Job Description Example
Our innovative and growing company is hiring for a healthcare analyst. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for healthcare analyst
  • Audit new and existing contracts in designated contract management system to ensure accuracy of rates and structure
  • Apply contract terms and conditions to internal client/facility processes and health plan payment strategies to improve reimbursement
  • Produce analytical reports to identify payment variances and quantify financial impact of payment problems or reimbursement discrepancies
  • Develop a corrective action plan to address the root cause of the systematic profitability and/or payment variance problem identified in the above-mentioned reports
  • Participate, as needed, in operational meetings or provide insight to internal management to address trends identified in reports
  • Assist in building of contracts in the designated contract management system
  • Build solid working relationships and a good rapport with internal customers
  • Assist with special projects regarding pricing, under/over payments, system implementations and business office education
  • Focuses on current, objective realities, and on using understanding of these realities to assist in making recommendation for the organization
  • Exercises personal drive and initiative to measure organizational performance, focusing attention on working with the financial business realities of the organization
Qualifications for healthcare analyst
  • Knowledge of healthcare business
  • Understand what data is needed to address a business question and how to analyze it and interpret results
  • Ability to write basic SQL and knowledge of relational databases
  • Strong familiarity with SQL and data mining
  • 1-3 years of financial analysis experience in a healthcare setting
  • Working knowledge of healthcare claims and revenue cycle
5

Healthcare Analyst Job Description

Job Description Example
Our company is looking to fill the role of healthcare analyst. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for healthcare analyst
  • Assist in the development and creation of reporting strategies (report cards, dashboards, exhibits, status reports, ) to keep external and internal leadership audiences apprised of progress towards departmental goals
  • Monitor and evaluate network adequacies/deficiencies with provider analysis and Geo-mapping
  • Support timely flow of network intelligence analysis to users by meeting deadlines and being responsive to request
  • Develop reporting of provider data to comply with state and federal regulatory requirements
  • Contribute to network and VBP analysis and presentations about network adequacy and performance using demographic, clinical, financial, and quality data
  • Develop provider profiling, segmentation, and review of network performance, including quality, cost, and care gaps identifying areas and specialties for targeted contracting and evaluating “what if” scenarios for changes to the network and payment structure
  • Provide support for VBP contract negotiations
  • Monitor VBP contract payment and calculations to ensure a match with contract terms
  • Research, analyze, present high quality results, and recommend intelligent solutions to solve problems and address business challenges by applying a knowledge of data analysis, critical-thinking skills, and healthcare experience/expertise
  • Assists team leadership with team oversight, the establishment of process consistency, execution of quality assurance, and overall delivery of exceptional business value
Qualifications for healthcare analyst
  • Ability to manage multiple projects, meet project deadlines
  • Working knowledge or understanding of measure authoring tools desirable
  • MBA, MHA, or MPH degree
  • Proven ability to analyze metadata from a health perspective
  • 5+ years related experience with metadata analysis in the field of healthcare / insurance data
  • Bachelor’s degree or equivalent in health informatics, computer science, statistics or mathematics

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