Senior Technical Consultant - Regulatory Reporting (Remote Eligible)

Senior Technical Consultant - Regulatory Reporting (Remote Eligible)

Requisition ID:

2024-42615Category:

AnalyticsLocation:

Remote Rev Hugh Cooper Admin Center, Albuquerque, NMRemote Eligible:

YesMinimum Offer:

USD $44.52/Hr.Maximum Offer:

USD $69.72/Hr.Overview

The Analytics Organization (AO) at Presbyterian Healthcare Services is one of the largest in the country! The vision of the AO is to transform data into insights, support strategic goals, and develop competitive differentiation. The work of our talented AO team members supports and promotes data-driven decision-making aimed toward improving the engagement and health of the members, patients, and communities we serve.As a key member of the

Health Plan Government Programs Informatics

team, the

Senior Technical/Analytics Consultant :Directly supports Clinical Operations. Understands Clinical Operations business processes, workflow and how it translates into reporting requirements.Works on requirements that drive the Clinical Ops workflow and how they translate into reporting requirements.Understands how the workflow is implemented in Jiva and tracks/monitors changes in Jiva to understand impact to regulatory reports.Codes complex Clinical Operations reports.The Human Services Department (HSD)

regulatory reporting

team directly helps our community! Presbyterian is the leader in Medicaid and Medicare in the state of New Mexico, representing 51% of the state program members.Additional Position Details:Full Time - ExemptRemote Eligible: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and OhioPreferred Qualifications:Extensive experience in

SQL ,

SAS

and Payor (health plan) sideClinical data

experienceExperience working with

Medicaid/ Medicare claimsExperience developing complex metric reportsExperience performing QA for regulatory reportsExperience driving business decisions and communicating with stakeholdersQualifications

Minimum Qualifications:Bachelors degree in a quantitative, business, or healthcare related subject. Masters degree or Ph.D. is highly preferred.Six (6) or more years of combined experience in business intelligence, reporting, analytics and health services research.Demonstrated project management skills as well as the ability to efficiently work and manage teams and resources.Experience working on complex analytical projects with diverse teams and developing data driven and outcome based initiatives to improve business decision making and operational efficiencies.Knowledge of health plan and delivery system operations, health care informatics, and healthcare benefits and terminology (e.g., care management).Understanding of operations in the Health Care industry and a strong acumen of business processes, including operations, delivery models and revenue models.Understanding of program evaluation life cycle, predictive modeling, data mining, and clinical best practices preferred.Experience in financial modeling, value analysis, and other financial management.Experience in health system finance, strategic planning or decision support analytics preferred.Content knowledge related to program outcomes evaluation, BI tools (e.g., BO), data visualizations tools (e.g., Tableau), statistical software such as SAS and Modeling techniques, as well as general health service research and outcomes reporting/analytics.Working knowledge of healthcare industry and healthcare information standards such as HL7, LOINC, FHIR, ICD 9/10 and CPT codes, industry standard groupers (e.g., ETGs, DRGs, DCGs, etc.) as well as of health care delivery system processes.Excellent written and oral communications.Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.Wellness:

Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinars, preventive screening and more.Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.About Presbyterian Healthcare Services:

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.Inclusion and Diversity:

Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses.

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