Senior Analyst - Data and Analytics
hace 5 días
Nashville
Company Description Spiras Health delivers personalized healthcare services at home, focusing on patients at high risk of emergency events or hospitalizations. By addressing the unique needs of individuals with chronic diseases, multiple health conditions, and other social determinants of health, Spiras Health enhances quality of life and reduces healthcare costs. Through collaboration with health plan providers and care management teams, the company employs local Clinical Care Teams to deliver tailored home-based care. Leveraging innovative technology, Spiras Health ensures efficient and effective program delivery. For more information, visit SpirasHealth.com. Who We Are: Excellence, Innovation, Passion, Compassion, Communication Spiras Health is a value-based, nurse practitioner led clinical provider of care-at-home and other health-related services to individuals with complex and polychronic needs. Spiras’ comprehensive approach to care delivery includes a combination of home-based services, telehealth, two-way digital communications, and remote patient monitoring. Proprietary predictive modeling identifies and assesses individuals with an elevated probability of avoidable costs. Spiras Health then develops actionable plans of care, addresses barriers including social determinants of health and delivers high quality patient care in collaboration with the patient’s treating physicians. Spiras’ innovative multi-modal care approach delivers improved satisfaction and clinical metrics as well as financial savings to its partners, through a geographically and economically scalable delivery model. Our culture is anchored on a promise of full accountability and integrity in everything we do. How We Serve: The Senior Data Analyst, in partnership with the Chief Financial Officer and Chief Commercial Officer, will design and develop market and opportunity analysis, monitor and measure contract performance, and model operational strategies and initiatives. Additionally, this role offers opportunity to engage with senior management and business unit leaders, contributing key insights that inform strategic decision making that ultimately supports the company’s growth. Job Summary: The Sr Analyst - Data & Analytics owns the integrity, analysis, and interpretation of payer claims data to support performance measurement, utilization management, and value-based care initiatives. This role is hands-on and accountable for claims QA, utilization metrics, and analytics outputs used by clinical, operations, and executive stakeholders. This is an individual contributor role with strong technical depth in payer claims data and healthcare analytics platforms, including MedeAnalytics. Key Responsibilities Claims Data Quality & Governance • Own QA processes for medical and pharmacy claims data, including eligibility, provider, diagnosis, procedure, and financial fields, • Identify, quantify, and resolve data anomalies (e.g., lag, duplication, missing claims, inconsistent coding), • Partner with data engineering, vendors, and payers to remediate data quality issues, • Define and maintain claims data validation rules and documentation Analytics & Utilization Management • Analyze and report on core utilization metrics, including:, • Inpatient admits / 1,000, • ED visits / 1,000, • Readmissions, • PMPM cost trends, • Length of stay, • Avoidable admissions, • Apply payer benchmarks (national, regional, risk-adjusted where applicable) to contextualize performance, • Support matched cohort, pre/post, and trend analyses, • Translate claims data into actionable insights for clinical and operations teams Platform Ownership (MedeAnalytics) • Serve as a power user and analytics owner of the MedeAnalytics platform, • Build, validate, and QA dashboards, reports, and analytic views, • Ensure alignment between platform outputs and internal data models, • Act as internal SME for MedeAnalytics capabilities and limitations Stakeholder & Team Collaboration • Partner closely with:, • Clinical leadership, • Operations, • Finance, • Growth, • Present findings to senior leadership in clear, non-technical language Required Qualifications • 5–8 years of healthcare analytics experience, • Deep experience working with payer medical and pharmacy claims data, • Strong understanding of utilization metrics and healthcare cost drivers, • Hands-on experience with MedeAnalytics (required), • Advanced SQL/SAS skills; experience with data visualization tools (Tableau, Power BI, or equivalent), • Proven ability to QA complex healthcare datasets, • Bachelor’s degree in Analytics, Statistics, Health Informatics, or related field Preferred Qualifications • Experience supporting value-based care, MA, D-SNP, or ACO programs, • Familiarity with HEDIS, Stars, or CMS reporting concepts, • Experience with risk adjustment (HCCs) Physical Requirements: • Prolonged periods of sitting at a desk and working on a computer., • This job operates in a hybrid professional environment free from noise and distraction. This role routinely uses standard office equipment such as computers and phones., • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job., • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus., • While performing the duties of this job, the employee is regularly required to talk and hear., • This position requires the ability to occasionally lift office products and supplies, up to twenty pounds. EEOC STATEMENT: • All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.