Data Management Strat & Gov Lead Analyst at Tailored Management, Inc.

Role Title:Data Management Strategy and Governance Lead Analyst

Role Summary
Participates in medical and non-medical code sets activities, providing healthcare code set knowledge and expertise to support, and maintain use and distribution of healthcare industry standard code set data as well as proprietary code set data. Focuses on the use of information and analytics to improve health and optimize consumer focused business processes. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings to drive the decision-making process and support business operations for internal customers in an effort to control medical cost and improve the quality of services provided to members. Performs research and analysis of complex healthcare and/or clinical data regarding network utilization, cost containment and quality improvement information. Responsible for research using multiple sources of data and analyzing algorithms to determine health care expenditures and utilization patterns. May also be responsible for designing and implementing the systems and programming to analyze and report findings. This position requires a high level of expertise in both analyzing medical data and information systems. May provide guidance or expertise to less experienced analysts



Responsibilities

• Provide healthcare code set knowledge and expertise to support, maintain, and assist in managing use and distribution of healthcare industry standard code set data
• Under general direction, and in collaboration with others, focuses on educating or sharing healthcare code set data knowledge to assist in improving and optimizing business processes, facilitate healthcare clinical and operational decision making, as well as support interoperable electronic reimbursement activities.
  Combines subject matter expertise in various healthcare industry standard code set content capabilities, including various reimbursement methodologies
• Maintains relationships with Operational / Implementation stakeholders
• Responsible for triage and resolution of Code Set issues and escalated when appropriate
• Update software tool with industry standard and proprietary reference data as needed
• Follows approved processes and procedures
• Ensures customer inquiries/requests are fully researched and responded to within established timeframes and responses are appropriate and complete.
• Communicates with team members and matrix partners regarding changes, production issues and business impacts
• Participates in the intake process
• Communicates with team members and matrix partners regarding errors and potential problems and provides appropriate follow up.
• Participates in the development of policies and procedures as needed.
• Work in collaboration with business, project and IT partners in support ofreference data changes and/or requirements as a result of enterprise projects.
• Maintains and protects confidentiality information.
• Ability to deal with multiple time zones and cultures
• Complies with all organizational and departmental policies and procedures.
• Performs other duties as assigned.

Qualifications

• Four year college degree or equivalent work experience.
• 5+ years healthcare claims/clinical operational knowledge
• CPC, RHIA, or RHIT
• Deep knowledge of Medical Code Sets (i.e. CPT, HCPCS, ICD) and their usage throughout the industry
• Knowledge of NCPDP, SnoMed, Rx Norm
• Intermediate to Advanced Excel skillset
• Excellent decision making abilities. Ability to analyze data and make decisions based on the information gathered.
• Strong verbal, written and presentation communication skills.
• Strong time management skills; highly organized and detail oriented.
• Ability to foster working relationships with business and IT team members.
• Proven result-oriented behavior.
• Ability to manage multiple high priority items in a fast paced environment.
• Strong team player with the ability to juggle work and multitask
• Ability to translate business data issues into solutions to meet multiple business needs; Strong analytical, problem solving, and process management skills
• Proactive flexible attitude, willingness to learn new skills; ability to accept ambiguity
• Ability to understand and facilitate the transfer of new reference data to downstream implementation teams
• Ability to understand technical needs of downstream systems and able to assess potential roadblocks for new updates

Preferred Qualifications:

• Experience working in an Agile delivery environment (Rally, Confluence, SharePoint, Git, etc.)
• Experience utilizing metadata management tools for business, technical and operational metadata (i.e Collibra, Teradata, Irwin, Web Portal, etc.)