Manager, Operational Analytics

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November 25

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WVU Medicine

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Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

10,000+ employees

⚕️ Healthcare Insurance

📋 Description

• Collaborate closely with the Director, Operational Analytics and colleagues across product, operations, medical management, and provider contracting to support and implement high-quality, data-driven decisions. • Ensure data accuracy and consistent reporting by designing, creating optimal processes and procedures for analytics employees to follow. • Use advanced data modeling, predictive modeling, and analytical techniques to interpret key findings from company data and leverage insights to help design, build, and manage the health plan. • Assist with the development of the monthly data loads for analytics vendors (HEDIS, risk adjustment, in-home assessments, lab kit and payment integrity vendors). • Act as subject matter expert who maintains up-to-date knowledge and interpretation of applicable regulations, CMS guidelines and requirements, and Medicare models. • Establish and lead data collection operations and process plans for the HEDIS and Risk Adjustment analytics tool and work with analytics vendor to ensure data aligns with requirements. • Support analyst team assisting with the Stars Program strategy, objectives, and initiatives through the creation of reports and analysis. • Collaborate with the HEDIS Program Manager and assist with data aspects of HEDIS program audits. • Assist with implementation of electronic record retrieval integration and maintain relationships with electronic record retrieval vendors. • Identify data to help the Quality Department impact HEDIS rates. • Support regulatory reporting strategy through the creation of reports and analysis for efficiency for the Plan. • Work cross functionally with the actuarial team to support repricing analysis and underwriting. • Build, develop and maintain data models, reporting systems and performance metrics to support key business decisions. • Ensure compliance with all applicable regulatory requirements, guidelines and contractual obligations set forth by CMS.

🎯 Requirements

• Bachelor’s Degree in Business Administration, Finance, Mathematics, Computer Science, Statistics, Information Systems, or a related field. • Six (6) years of experience monitoring, managing, manipulating, and drawing insights from data in a managed care company. • Three (3) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk. • Foundational understanding of health plan economics and financial drivers. • Master’s Degree in Business Administration, Computer Science, Statistics, Information Systems, or a related field (preferred). • Experience working in an analytic capacity collaboratively with Medical Economics, Risk Adjustment, Quality, Actuarial or Finance functions within an insurer focused in Government/Commercial products (preferred). • Experience with Medicare and/or Medicaid Regulatory Reporting (preferred). • Foundational understanding of prescription drug programs (preferred).

🏖️ Benefits

• Health insurance • Flexible work hours • Professional development opportunities