Senior Analyst - Provider Network Ops - Paramount - Full Time - Days
ProMedica’s health plan, Paramount Insurance, offers health insurance products across six Midwest states. Paramount is an Ohio-based health insurance company, headquartered in Toledo. The organization has more than 800 employees dedicated to serving their health plan members.
Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.
In addition, Paramount has a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation, as well as vocational rehabilitation, life-care planning and wellness.
As a part of ProMedica, Paramount is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount strives to provide an exceptional experience to every member. For more information about Paramount, please visit our website. http://www.paramounthealthcare.com.
Under general direction, provides consultation on the design, testing, and enhancement of reporting systems. Researches, manipulates, and prepares data related to health management programs that document program activities and the results of health management interventions. Typically includes creating various machine learning-based tools or processes within the company, such as recommendation engines or automated lead scoring systems. Performs statistical analysis to build Artificial Intelligence tools that automate certain processes within the company and create data science algorithms (e.g. regression, classification and clustering techniques, decision trees and random forests, machine learning techniques like supervised, unsupervised and reinforcement learning). Typically has five or more years of experience in data science and holds a Ph.D. in a quantitative/research discipline. Normally reports to Manager, Data Science.
1. Model the impact of changes in provider reimbursement terms and fee schedules including the ability to use various datasets to draw conclusions, identify trends and reach credible and solid conclusions through use of third party and in-house software applications.
2. Prepare standard and ad-hoc reports and presentations to senior leadership, regulators, and industry stakeholders in a clear and actionable manner.
3. Use in-house applications to create new, experimental data frameworks for exploration and analysis.
4. Correlate similar data and build custom algorithms to derive actionable insights or determine root causes.
5. Manage (and collaborate on) analytics projects from concept inception to operational deployment.
6. Interpret and analyze data using exploratory mathematics and sound statistical techniques.
7. Use predictive/prescriptive modeling to optimize the quality and value based performance of applicable provider organizations and to inform Paramount action and strategy with respect to proprietary, state, and federal programs.
8. Develop processes and tools to monitor and analyze model performance, data extracts, and accuracy.
9. Work closely with and develop a comprehensive understanding of Medicare, Medicaid, and Paramount’s claim editing approach.
10. Other duties as assigned.
Education: Masters degree in Business, Finance, Math, IT, or Statistics required.
Skills: A high degree of skill and expertise in using all Microsoft tools, particularly Excel. Knowledge on a variety of machine learning techniques and statistical concepts and their real-world applications. Excellent verbal and written communications skills sufficient to interact with all levels of employees required. Ability to plan, coordinate, and organize multiple priorities with minimal supervision. Ability to prepare and deliver effective presentations to internal and external customers.
Years of Experience: Minimum of 5 years business experience required.
Education: PhD degree.
Skills: Ability to write code, working in a variety of languages such as R, SAS, SQL, or other comparable tools. Experience with Milliman and/or Truven reporting tools and ODM reporting and program requirements.
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact email@example.com
Equal Opportunity Employer/Drug-Free Workplace
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