Senior Technical Consultant - Regulatory Reporting (Remote Eligible)

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 a 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 - Exempt
• Remote Eligible: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio

Preferred Qualifications

• Extensive experience in SQL, SAS and Payor (health plan) side
• Clinical data experience
• Experience working with Medicaid/ Medicare claims
• Experience developing complex metric reports
• Experience performing QA for regulatory reports
• Experience driving business decisions and communicating with stakeholders

The Government Informatics Team:
To ensure that all Managed Care Organizations support our Medicaid recipients as desired, New Mexico's Human Services Department (HSD) takes a data-driven approach with significant reporting requirements along with emergent ad hoc requests to respond to current needs.

The Government Informatics team was formed to build a scalable, sustainable process to support this intensive data-driven process.

• Delivers a large suite of reports in conjunction with business stakeholders across the health plan - automating to enable the delivery of over a hundred reports and data marts.
• Works closely with business stakeholders analyzing back end data and aligning with front end processes to create a representation of the data that accurately portrays the work that PHP is completing.
• Develops a thorough understanding of business processes to enable quality checks and responsive report updates as requirements change.
• Leverages Robotic Process Automation (RPA) to automate complex manual processes, reducing errors and increasing efficiency.
• Focuses on data engineering to improve data integrity across reporting through the use of data marts that normalize and standardize commonly used data.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

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.

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, webinar, 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.

#LI-nonclinical

#ITA123