Manager, Operational Analytics

About Wvumedicine

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Job Summary

The Manager, Operational Analytics will collaborate closely with the Director, Operational Analytics, as well as other colleagues, across product, operations, medical management, and provider contracting to support and implement high-quality, data-driven decisions. The ideal candidate will be the subject matter expert for both Commercial and Government Programs data and analytics. They will ensure data accuracy and consistent reporting by designing, creating optimal processes and procedures for analytics employees to follow. They will use advanced data modeling, predictive modeling, and analytical techniques to interpret key findings from company data and leverage these insights that will help us design, build, and manage our health plan.

Key Responsibilities

• Assist with development of the monthly data loads for our various analytics vendors, such as HEDIS and risk adjustment, in-home assessments, lab kit and payment integrity vendors.
• Acts as subject matter expert who maintains up-to-date knowledge and interpretation of applicable regulations, CMS guidelines and requirements, and Medicare models.
• Establish and lead the data collection operation and process plans for the HEDIS and Risk Adjustment analytics tool.

Required Qualifications

• Bachelor’s Degree in Business Administration, Finance, Mathematics, Computer Science, Statistics, Information Systems, or a related field.
• Six (6) years of experience monitoring, managing, manipulating, and drawing insights from data in a managed care company.
• Three (3) years of experience working with claims data to evaluate reimbursement changes, payment discrepancies, medical expense opportunities, quality outcomes and risk.
• Foundational understanding of health plan economics and financial drivers.

Preferred Qualifications

• Master’s Degree in Business Administration, Computer Science, Statistics, Information Systems, or a related field.
• Experience working in an analytic capacity collaboratively with Medical Economics, Risk Adjustment, Quality, Actuarial or Finance functions within an insurer focused in Government/Commercial products.
• Experience with Medicare and/or Medicaid Regulatory Reporting.
• Foundational understanding of prescription drug programs.