Healthcare Claims Data Analyst (ORS/CQCT)

Healthcare Claims Data Analyst (ORS/CQCT) 71091324 Do you have a passion for provides administrative and logistical support that includes arranging meetings and webinars, compiling, and circulating documents such as protocols and operations manuals, preparing presentations and Data Use Agreements? If so, this might be the position for you! About the division: The Health Care Authority’s mission is “Provide high quality health care through innovative health policies and purchasing strategies.” The Clinical Quality and Care Transformation (CQCT) Division has the purpose of designing and implementing clinical policy; conducting oversight and monitoring of all clinically related programs; and communicating with stakeholders, providers, plans, and delivery system partners on clinical activities and issues. The Data Team (DATA) of the Health Care Authority is responsible for leading the Washington State Health Information Technology (HIT) strategy; leading Data Governance strategy for the Agency; and leading the implementation, maintenance, and enhancement of the data management, analytics and reporting systems that inform Agency leadership in support of HCA’s purpose and goals, as well as for improving and monitoring agency and program performance to ensure accountability and alignment with all agency activities. About the position: The Healthcare Claims Data Analyst performs statistical data analysis and analytic projects in the specialized area of all-payer healthcare claims data and acts as the healthcare study data analyst within the WA-APCD program. This position develops and designs complex operations and research using statistical, data mining, analytical and visualization methods to investigate and answer complex healthcare issues using traditional and emerging data analysis techniques. The data, tools, presentations, and analyses generated by the position focus on original healthcare, policy and operations research and will be used for high profile, legislatively mandated initiatives, ad hoc data reports for multiple stakeholders, and internal policy and program decision-making. The position develops advanced analytics using agency approved enterprise data tools and programming languages and requires in-depth and specialized subject-matter expertise of medical, pharmacy, dental, eligibility and provider claims data. This position is comparable to a Program/Data Analyst position. This position is eligible to telework and is typically not required to report on-site. Travel may be occasionally required for meetings. Travel is primarily in state. The default assigned work location of all Health Care Authority (HCA) positions – both on-site and telework eligible positions – is within the State of Washington. Frequency of onsite work will vary based on business and operational needs. HCA may choose, but is not required, to support out-of-state telework on a case-by-case basis. Some of what you will do: • Analyzes complex healthcare claims and associated healthcare service delivery data to respond to new, incoming, and complicated program and public reporting needs and requests. Actively uses SAS, R, SPSS and/or SQL languages and software applications to write data code/query scripts and independently develops complex quantitative and qualitative analyses to address these requirements. • Designs analysis and risk models for outcomes research, comparative analysis, patient stratification, and outlier monitoring and performs sophisticated data analyses and clearly demonstrates the relationships among claims variables, including the effect size and the statistical significance of the association. • Contributes to the development of new healthcare knowledge by developing and refining data analysis approaches in collaboration with colleagues across sister WA agencies and institutions supporting data-driven efforts to identify inefficiencies and irregularities in the provision of care. • Understands and applies medical coding (e.g., ICD-10) to analyze complex healthcare data from multiple sources; draws on experience in dealing with several coding systems and coding irregularities (e.g., defining episodes of care for a bundled payment reimbursement system). • Determines valid conclusions and develops appropriate recommendations and key insights and works collaboratively with partners and subject matter experts so that analysis results are presented in a comprehensible and interpretable manner appropriate to the audience (e.g., legislators, agency leadership, providers, etc.). • Actively engages and collaborates with HCA staff and other data teams to perform methodological peer review and works with stakeholders (e.g., agency management) to determine approach that supports program decisions and processes (e.g., WA-APCD public reporting priorities). • Participates in ongoing and new data validation efforts with the data vendor and various data submitters (private and public healthcare payers, including third-party adm