Senior Analyst, Performance Suite Analytics

Role Overview

• Support the clean data transfer between Evolent and its customers in the Performance Suite where Evolent does not pay claims.
• Support the design of data transfer protocols during client onboarding and implementation, and refinement efforts on an ongoing basis.
• Develop models to evaluate data quality on a regular basis to uncover irregularities in data submitted from clients and work cross-functionally to identify the root cause.
• Apply post-pay audit and payment integrity methods and techniques to ensure claims were paid according to policy
• Coordinate with internal teams to ensure clean and consistent tracking of Evolent’s covered membership and claims
• Support the design of standardized processes, templates, and collateral for key client-facing financial activities
• Create models to assist in financial scope reconciliation efforts.
• Identify potential risks and opportunities related to partner data, enabling leadership to better resource solutions, negotiate contractual terms, or settlements.
• Perform ad hoc client-specific analyses to support strategic decision-making

Requirements

• Bachelor’s degree, preferably with a quantitative major (e.g. actuarial, statistics, operations research, mathematics, economics) or healthcare focus (health administration, epidemiology, public health, biology)
• 1-3 years of professional experience in claims-based healthcare analytics with a payer, provider, clinical vendor, managed care, or related healthcare consulting entity
• Ability to communicate clearly with diverse stakeholders to solve problems; ability to translate between business needs and analytical needs
• Exceptionally strong analytical abilities, with track record of identifying and communicating insights from quantitative and qualitative data
• Advanced or higher proficiency in SQL or SAS database/statistical programming languages and Microsoft Excel
• Experience using data visualization software (s) to package analytical insights (Power BI, Tableau, or similar)
• Experience in data mining, advanced/ statistical analysis, and data manipulation
• Familiarity with healthcare reimbursement methodologies and calculations such as DRGs, Revenue Codes, CPT Codes, RVUs, bundled payments, etc.
• Master’s Degree, especially with a quantitative focus (e.g. data science, machine learning, statistics, mathematics, computer science, or engineering)
• Preferred
• Working knowledge of healthcare claims; specifically, differences between institutional vs professional billing and various sites of care/service
• Preferred.
• Familiarity with value-based care and utilization management
• Preferred.
• Understanding data systems and critical thinking skills to solve new problems and adapt to changes in data architecture
• Preferred.

Tech Stack

• SQL
• Tableau

Benefits

• comprehensive benefits (including health insurance benefits)