Health Data Analyst I

Summary: Upper Peninsula Health Plan is seeking a Health Data Analyst I to analyze health plan data related to health services delivery and costs. The role involves collaborating with staff to support data analysis needs and producing monthly data reports. Responsibilities: - Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information - Collaborates with internal health plan staff to define data analysis projects, identify appropriate data sources, and develop meaningful and actionable output. Provides coaching and guidance to staff and acts as a resource for clinical, claims and finance staff on data analyses needs - Produces and analyzes monthly data reports for medical and pharmacy expense, revenue reconciliation, clinical utilization management and claims payment. Identifies and escalates potential issues to department directors - Organizes, sorts, and filters data in order to distinguish patterns and recognize trends. Develops and maintains data preparation and validation routines to support data mining. Reviews reports to ensure the accuracy and validity of presented information - Utilizes tools such as SQL and Microsoft Office products (Excel, Access, PowerPoint, Word, and Visio) - Solves moderately complex problems and/or conducts moderately complex analyses. Escalates issues as necessary to the Data Infrastructure Manager - Collaborates with the Compliance Officer to provide detailed data analysis activities for potential fraud, waste and abuse identification - Attends educational seminars as required; maintains knowledge of current billing, reimbursement and clinical coding schemes; attends department meetings; serves on committees and participates in workgroups as required - Maintains confidentiality of client data - Performs other related duties as assigned or requested Required Qualifications: - Bachelor's degree in an appropriate science or related discipline such as health information technology, health information management, computer information systems or related field - One (1) to three (3) years of coursework related to data analysis or computer science - Understanding of SQL and MS SQL Server - Excellent project management and organizational abilities - Excellent human relation and oral/written communication - High level of technical and problem-solving skills - Keyboarding proficiency and advanced knowledge of MS Office (Word, Excel, Access, PowerPoint) - Ability to access departmental files - Ability to enter and access information from a computer - Ability to access all areas of the UPHP offices - Moderate physical effort (lift/carry up to 25 pounds) - Occasionally lifts supplies/equipment - Occasional reaching, stooping, bending, kneeling, crouching - Prolonged periods of sitting - Occasional prolonged standing - Manual dexterity and mobility - Works in office conditions, but occasional travel may be required - Exposure to situations requiring exceptional interpersonal skills or periods of intense concentration - Subject to many interruptions - Occasionally subjected to irregular hours - Remote work optional; based on attainment of policy eligibility criteria and subsequent application and approval Preferred Qualifications: - Bachelor's degree in an appropriate science or related discipline as above with a dual major or minor in mathematics - One (1) to three (3) years of experience developing reports or analyzing data in a healthcare environment - Knowledge of accounting software systems/applications - Knowledge of claims and coding and billing methodologies - Knowledge of clinical HEDIS, NCQA and CMS regulations Required Skills: SQL, MS SQL Server, Microsoft Office, Data Analysis, Healthcare Data Analysis, Claims, Billing Methodologies, Clinical HEDIS, NCQA Regulations, CMS Regulations, Human Relations, Project Management, Organizational Abilities