Senior Provider Analytics Consultant
Highmark · United States
- Hybrid
- Full-time
- $164,000 / year
- United States
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Job highlights
- Analyze provider data for compliance and automation.
- Develop advanced reports and analytic tools.
- Automate workflows using M365 tools.
- Collaborate with strategic partners on reporting.
- Drive value-based reimbursement initiatives.
About the role
Job Summary
The Senior Provider Analytics Consultant will focus on critical data management, regulatory compliance, and automation within provider functions at Highmark. This role requires advanced proficiency in data manipulation and analysis for code enhancement and Quality Assurance (QA) of regulatory reports. Expertise in Excel, SAS, SQL, and Power BI is essential, along with the ability to develop testing plans for system and report enhancements. A significant part of this role involves automating team workflows and improving operational efficiency using M365 tools. Deep familiarity with CMS and state provider data requirements, provider data within the Health Insurance Managed Care Organization (MCO) realm, and provider network management/adequacy standards is crucial. The role contributes to delivering high-quality analytics and insights for program design, serves as a subject matter expert on provider data, and drives innovation and process improvement.
Essential Responsibilities
- Develop complex and innovative internal/external provider reports and analytic tools highlighting key performance indicators for value-based reimbursement programs and analyzing financial/quality performance trends. Engineer reports for self-service capability.
- Drive collaboration across analytic groups to ensure comprehensive and accurate reporting.
- Proactively design complex scorecards and dashboards using advanced analytic tools to support value-based reimbursement arrangements with strategic partners.
- Engage with key strategic partners to understand their use of reports, anticipate needs, and drive strategy for reporting/analytic tools.
- Support the creation of impactful value-based reimbursement programs across the enterprise for various provider types. Anticipate technical hurdles and leverage experience to drive positive outcomes.
- Interpret raw claims, provider, quality, and member data to build datasets for analysis and reporting. Utilize multiple programming and query tools effectively.
- Research and implement process improvements and automation for existing reports. Communicate best practices across the department.
- Lead provider cost savings analyses related to value-based reimbursement and communicate potential cost-saving initiatives to stakeholders.
- Report on financial outcomes of value-based provider arrangements and provider incentives. Identify potential risks and opportunities, and define scenarios for achieving specific outcomes.
- Enhance department influence through responsive service and expert consultation. Present information and provide decision support to team members and senior management.
Key Skills/Competency
- Provider Analytics
- Data Management
- Regulatory Compliance
- SAS
- SQL
- Power BI
- M365 Tools
- Health Insurance MCO
- Network Adequacy
- Value Based Reimbursement
Skills & topics
- Provider Analytics
- Data Management
- Regulatory Compliance
- SAS
- SQL
- Power BI
- M365
- Healthcare Analytics
- Managed Care
- Value Based Reimbursement
- Consultant
- Analytics
- Reporting
- US Citizen
How to get hired
- Tailor your resume: Highlight 10+ years of relevant analytic experience and MCO/healthcare industry knowledge, emphasizing SAS, SQL, and Power BI skills.
- Showcase expertise: Quantify achievements in developing complex reports, driving automation, and supporting value-based reimbursement programs.
- Address requirements: Explicitly state US citizenship due to contractual needs in your application or cover letter.
- Prepare for interviews: Be ready to discuss your experience with provider data, regulatory reporting, and strategic partner collaboration.
- Demonstrate M365 skills: Highlight examples of workflow automation and efficiency improvements using M365 tools.
Technical preparation
Master SAS, SQL, and Power BI for data analysis.,Practice developing complex regulatory reports.,Automate workflows using M365 tools.,Review CMS and state provider data requirements.
Behavioral questions
Describe a complex analytic challenge you solved.,How do you ensure regulatory compliance in reporting?,Share an experience automating a team workflow.,How do you collaborate with strategic partners?
Frequently asked questions
- What specific provider data knowledge is required for the Senior Provider Analytics Consultant role at Highmark?
- The Senior Provider Analytics Consultant role at Highmark requires deep familiarity with CMS and state provider data requirements. You should also have a strong understanding of provider data within the Health Insurance Managed Care Organization (MCO) realm, including provider network management and network adequacy standards.
- What programming and query tools are essential for this Highmark position?
- Essential tools for the Senior Provider Analytics Consultant at Highmark include Excel, SAS, SQL, and Power BI. Proficiency in multiple programming and query tools is expected, and you will be a resource to less experienced teammates in this area.
- Does Highmark offer remote work for the Senior Provider Analytics Consultant role?
- The Senior Provider Analytics Consultant position at Highmark is listed as 'Office- or Remote-based,' indicating flexibility. However, final work arrangements may depend on specific team needs and company policies.
- What is the required educational background for the Senior Provider Analytics Consultant at Highmark?
- A Bachelor's degree in Mathematics, Statistics, Finance & Accounting, Actuarial Science, Economics, or a related field is required. Alternatively, six years of relevant work experience can substitute for a Bachelor's degree.
- What kind of experience is preferred for the Senior Provider Analytics Consultant role at Highmark?
- While 10 years of relevant analytic work experience is required, Highmark prefers candidates with an additional 10 years of experience specifically within the insurance or healthcare industry.
- Is US citizenship a mandatory requirement for this Highmark job?
- Yes, US citizenship is a mandatory requirement for the Senior Provider Analytics Consultant position at Highmark due to contractual and access requirements.
- What are the primary responsibilities of a Senior Provider Analytics Consultant at Highmark?
- Primary responsibilities include developing advanced provider reports and analytic tools, driving regulatory compliance, automating workflows with M365, supporting value-based reimbursement programs, and acting as a subject matter expert on provider data.
- How does Highmark approach salary for this role?
- Highmark determines base pay for the Senior Provider Analytics Consultant based on qualifications, experience, expected contributions, internal peer equity, market conditions, and business considerations. The provided salary range is $102,700.00 to $164,600.00.
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