"Under moderate supervision, Informatics Analyst II will be responsible for administrative and analytical support of provider incentive programs, including preparation and development of reports, presentations, explanations of payments, and other documents as needed to manage provider inquiries. This requires a working knowledge of incentive program design and contract-specific terms regarding incentive programs, payment obligations, and performance / payment reporting. This individual will also be responsible for payment obligations, tracking of participating groups and providers, and reporting for HPHC’s Care Delivery Model (CDM) pilots, as well as several state-based multi-stakeholder Patient Centered Medical Home (PCMH) initiatives and Accountable Care Organization participating groups.
The Analyst II will also assist with other ad-hoc analyses in support of incentive program design, reporting, and management as well as execute standard and ad-hoc analysis in support of Shared Savings models, PCMH, and CDM Pilots, using both standard population based reporting and new episode based reporting from Optum.
This individual must be proficient in the use Microsoft analytic tools (Access, Excel), as well as communication tools (Word, Power Point). Experience with SQL and/or similar analytical applications and/or visualization tools preferred. Strong interpersonal skills and the ability to work in a multidisciplinary team environment required.
•Maintain database of contract terms for Pay for Performance (P4P) and Other Provider Payment (OPP) programs, as obtained from contracting managers. Utilize database to maintain inventory of measures, definitions, and technical specs for use in communicating to physician group leadership and external customers (Association of Health Insurance Plans, Massachusetts Association of Health Plans, state regulators, etc.)
•Based on performance data inputs related to various P4P domains, prepare calculations, payment documentation, Explanation of Payments for payee. Prepare payment authorization documentation, managing payment status and ensuring timely signoff and payment processes. Work with Provider Accounting on issues related to incentive payments; Maintains awareness of and compliance with required audit and accounting standards. Manage processes to ensure timely payments to providers, including tracking payment process status
•Maintains processes to collect Health Information Technology (HIT) functionality status. Develops and maintains processes and systems to track Meaningful Use status. Tracks submissions of clinical lab and other biometric data, in lieu of quality coding using administrative data, ensuring that data imported into corporate data warehouse, per defined processes (yet–to-be determined)
•Create internal reporting of payment earnings for use by finance/budget, Contracting, Health Services Management.
•Create presentations for external meetings with provider entities, including executive summaries as well as performance detail. Work closely with Provider Contracting to review and present provider performance in incentive programs, and areas for improvement. Participates as requested in quarterly partnership meetings with Capitated and Shared Savings physician groups.
•Support other external reporting, such as RFP Team responses and stakeholder or regulator requests by supplying qualitative program information, as well as quantitative results on participation rates, performance, and payments.
•Perform tasks involved in implementing honor roll and physician tiering programs
•Responsible for ongoing communication with customers, providing project status, resolving issues, coordinating continued involvement to meet original expectations or jointly agreed upon adjusted expectations
•Manages data audit processes to support valid measurement processes and requests for appeals per HPHC policy as aligned with Massachusetts Medical Society/Patient Charter. Ensures “cleaned” data is used in reporting performance to physician groups.
•Coordinates identification of PCMH and CDM providers, through inputs from National Committee for Quality Assurance, statewide stakeholders, and CDM teams; maintains database of provider identities, links to practice sites, and participation in various HPHC and external initiatives; creates and maintains reference table for upload into corporate data warehouse to enable standard reporting for PCMH and CDM Pilot sites by Medical Informatics, Network Medical Management, and Finance.
•Provides support, as needed, to design and implementation team for Network Data Management (NDM/Portico), including documentation of current data structures and processes; design of PCMH subnetwork definitions, and user acceptance testing as implementation proceeds (as requested)
•Executes both standard and drill down reporting from corporate data warehouse based tools (Microstrategy, Optum) to respond to customer requests for more in depth performance analysis (external physician groups, internal Network Medical Management, Contracting)
•Provides timely quality assurance oversight of reporting delivered to physician group leadership.
•Serves as Medical Informatics representative on key data stewardship teams (e.g., provider, claims, Business Intelligence)
•Executes reporting in ongoing support of PCMH multistakeholder initiatives and CDM pilots, using Microstrategy and Optum tools.
•Perform ad hoc performance analyses, as required by ongoing project work.
"Bachelors in Business Administration, Finance, Health Services or equivalent. Masters preferred.
Deadline to apply: 9/15/2012
•3-5 years business experience, preferably in managed care or provider environment
•Working knowledge of the fundamental concepts, practices and procedures of financial and utilization data analysis
•Must have experience manipulating and analyzing claims data and be familiar with reimbursement terms and concepts
•Must be proficient in the use of SAS and/or Microsoft Access, Microsoft Excel, and Microsoft Word
•Strong interpersonal skills and the ability to work in a team environment required
•Excellent verbal and written communication skills, ability to work in a team environment and independently as needed, working knowledge of healthcare reimbursement methodologies, ability to manage multiple projects simultaneously, aptitude for detail-oriented work
•Must be comfortable working with and presenting to all levels of management as well as external (provider) audiences