Health Care Data Consultant

Today's healthcare industry -- dynamic and changing at a fast pace. Recruiting talented people can mean the difference between success or failure. At Blue Cross and Blue Shield of Massachusetts, our record of achievement represents a history of hiring the best people we can find, and then challenging them to excel. It's the kind of environment that enables us to give our best to the consumers we serve, and at the same time, work to the potential of those who work for us. Blue Cross Blue Shield of Massachusetts is an Equal Opportunity Employment/Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, or any other characteristics protected by law.Position SummaryThis position has responsibility for contributing to the development, implementation, and management of outsourced health management programs and partners through Contracted Health and Wellness (CHW) partner initiatives. Such initiatives generate administrative expenses of approximately $75 million annually and impact an estimated 370,000 members in disease management and entire product networks for activities such as utilization management. These partnerships typically serve our members with chronic or very complex conditions who require the highest levels of medical services and generate amongst the highest levels of medical expense. The responsibilities of this position are focused on assisting in the design and development of data exchange and reporting processes, collaboration with the partners to assure complex data system interfaces are appropriately managed, and data analysis of potential arrangements, existing arrangements, and program results. Ongoing operational data analysis is also required to meet the needs of various internal and external stakeholders including analysis to evaluate potential tactical or strategic changes to programs and processes. Responsibilities Provide subject matter expertise required to define and develop processes and systems to generate complex analytical services integral to the development of CHW health management outsourced arrangements and partnerships Project manage initiatives requiring multifaceted data analytics Lead cross-functional teams and initiatives related to data research, analysis, and reporting Manage a continuum of data exchange processes established with external and internal vendor and BCBSMA resources within appropriate timelines Interpret and translate as necessary information provided by vendors and other BCBSMA areas for purposes of further interrogating data and generating actionable reports Independently develop and recommend solutions for enhancing the creation and review of complex data and effectuating operational efficiencies related to vendor or BCBSMA processes Contribute to the development and facilitation of new and innovative contracting approaches through appropriate analytical activities. Participate as appropriate in contract negotiations Develop and implement standardized data exchange, data analysis, and data/process documentation protocols that are clear and auditable Develop and generate from large volumes of available data streamlined actionable reports to assist Senior Management in decision making Develop and utilize technological tools to manage the tracking and reporting of multiple interactive data fields Develop and monitor externally and internally generated outcomes data for purposes of measuring the performance of outsourced arrangements Assist cross-functional BCBSMA areas and partners to develop tools and processes to streamline workflows and improve operation of health management programs Continuously collaborate with Clinical Coordination, Actuarial, Finance, IT, Account Reporting, Informatics and outsourced resources in similar areas to manage more effectively internal and vendor relationships Demonstrated strength in financial and operational data analysis Proficiency in Excel, Access, and other database management tools Programming and system testing skills; knowledge of SAS is a plus Demonstrated ability to influence and operate collaboratively in a team partnership environment Demonstrated customer and provider focus BA/BS required; Masters preferred 5-8 years demonstrated health care finance experience; demonstrated financial analysis and modeling experience; experience working with outside vendors or providers Experience with a production data exchange process Knowledge of BCBSMA systems including eligibility, claims, accounting, and basic core components is preferred Position Information Location:  Boston, MA 02215 Job Category:  Business/Strategic Management Reference Code:  bcbs-00001521 Our commitment to building a diverse workplace is without question. We are an Equal Opportunity Employer.