Resp & Qualifications
Resp & Qualifications
PURPOSE: The Sr. Reporting Data Analyst on the Inter-Plan and Blue Market Strategy Team will have responsibilities which can include complex coding to create, transform and accomplish data manipulation involving data matching, merging, cleaning and modifying claims data and provider data; at the same time, working with the different business area in Sales, Health Services, Networks Management, external support vendors and Blue Plans to drive growth and retention.. The primary objectives are as follows: (a) Work with Sales and cross-functional data teams to review reports being created as well as provide detail analysis of data issues identified, providing business rules guidance on data analysis; (b) create user defined reports and provide ad-hoc analytics, provide secondary support for Inter-Plan and national account analytics.
Duties and Responsibilities
1. Sales and Inter-Plan support: The incumbent will be primarily responsible for the creation, maintenance and validation of specific reports and analytics. Working with Data and Informatics during the validation of the NDW (national data warehouse) submissions to ensure data validity and comparability with internal standards.
2. The incumbent will be able to ascertain the feasibility of information requests and develop procedures and methods to acquire the information needed. Develop, test, and implement efficient and maintainable program logic for existing and new reports in accordance with the business specifications. Generate clear and concise documentation as required within the programs and application documentation repository to translate reports into programmable modules for production. Knowledge of source systems such as Facets, NetworX Pricer and Portico is imperative as well as an understanding of BlueWeb and Consortium Insights.
3. The incumbent must be able to analyze and translate functional specifications into technical specifications including an estimated level of effort Includes prioritizing tasks, projecting the hours needed to complete the project; designating milestones and/or due dates within project timeframes as appropriate and meeting those timeframes. Associate needs to be able to ascertain the accuracy and validity of the data used for reporting, which is accomplished by detail checking of individual records and line items, as well as checking for reasonableness, before releasing information and balancing against independent sources.
4. Work closely with different areas Sales, Health Services, Actuarial, and Networks Management in terms of creating ad-hoc reports and translating business needs to business rules that will be used in programming and creation of reports.
A college degree in Healthcare, Information Systems, Computer Science, or a related discipline with 4-6 years of analytics and/or business reporting experience in a healthcare environment or equivalent total experience is required.
• Demonstrated ability to develop systems, programming logic, effective reporting formats, and summary analysis is required
• Demonstrated strong data analytical skills, organizational, and problem solving skills are required
• Proficiency in web-based intelligence tools, such as Business Objects, ProClarity is desired but not required.
• Working knowledge of Facets, NetworX Pricer or Portico is preferred.
Expertise in related healthcare fields and proficiency using profiling tools such as DRGs, CPT and HCPCS codes is strongly preferred. Experience with Provider Contracting or Provider Reimbursement is strongly preferred, as well as financial reporting and analysis.
Knowledge of CareFirst organization, operations and adjudication systems is preferred but not necessary. Knowledge of DC and MD mainframe applications including BCIQ, PVXI and PV40 is desirable but not required.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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