Aetna Business Information Analyst in Richmond, Virginia
Req ID: 54347BR
The Business Information Analyst defines, develops and provides information and analysis to drive the decision-making process and support business operations for internal and external customers with respect to reporting and controlling medical cost of services provided to members. Manages the production and analysis of medical cost information used to formulate effective network contracting and management strategies. Retrieves, organizes and performs analysis on data, is actively involved in decision making process to provide results against plan objectives. This position works closely with the QM Director and the Information Systems Director/Manager.
Aggregates disparate data sets and analyzing data with the intent of identifying trends and opportunities for improvement.
Reviews data across populations and programs, including data from vendors such as Behavioral Health, Pharmacy, transportation etc.,
Responsible for facilitating and responding to ad-hoc data requests from the State and internal business units, coordinating, reviewing and validating all data and reports sent to the State.
Acts as a resource to ensure appropriate data and data analytic support and services are available to support rapid-cycle process improvement efforts across the enterprise and to meet all reporting and quality improvement efforts under the contract.
Work closely with health plan staff such as the QM Director and the Information Systems Coordinator.
Reviews data across populations and programs, including data from vendors such as Behavioral Health, Pharmacy and transportation.
Analyzes more complex types of capitated and fee-for-service provider contracts and presents results against budgets and benchmarks, performs variance analysis.
Responsible for facilitating and responding to ad-hoc data requests from the State and internal business units.
Responsible for coordinating, reviewing and validating all data and reports sent to the State.
Acts as a resource to ensure appropriate data and data analytic support and services are available to support rapid-cycle process improvement efforts.
Responsible for meeting all reporting and quality improvement efforts stipulated by the KanCare contract.
Produces more complex ad hoc reports to satisfy information needs across products/segments and markets.
Develops provider compensation and fee schedules.
Provides consultative support to network managers with legitimacy testing of rate proposals.
Utilizes, maintains and develops pricing models and medical cost tracking tools (eg. PMODEL).
Provides more complex and detailed analysis and support for planning and forecasting of medical costs including the development of gross medical trend estimates.
Supports the development of scoreable action items by identifying outlier cost issues, providing ad hoc analysis and generating ideas for moderation of trend increases.
Identifies overpayments and prepares projects for recovery.
Determines strategy presentation of hospital charge master reports to implement rate adjustments.
Background/ Experience Desired:
Minimum of 2-5 years experience in the managed care industry with knowledge of provider contracting, provider reimbursement, patient management, product and benefits design.
Minimum 3 years of experience aggregating disparate data sets and analyzing data with the intent of identifying trends and opportunities for improvement.
Advanced skills in SQL, Excel, MS Access and Web-based query tools (MCM, data warehouse).
Ability to learn new technologies.
Strong analytical ability and familiarity with advanced financial and healthcare concepts.
Demonstrates critical thinking and expresses ideas clearly, concisely and logically from a cross functional perspective.
Ability to manage conflicting priorities and multiple projects concurrently.
Demonstrates initiative, innovation and leadership in achieving results.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Finance/Creating Profitable Customers/ADVANCED
Finance/Delivering Profit and Performance/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED
General Business/Communicating for Impact/ADVANCED
General Business/Demonstrating Business and Industry Acumen/ADVANCED
Leadership/Collaborating for Results/FOUNDATION
Additional Job Information:
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.