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Reporting Analyst

Company: Partnership HealthPlan of California
Location: Fairfield
Posted on: September 23, 2022

Job Description:

The Grievance & Appeals Reporting Analyst plays a vital role in root-cause analysis of case trendsand satisfying Partnership HealthPlan's reporting obligations to internal and externalstakeholders. Responsible for ongoing development and implementation of quantitative dataanalysis and reporting capabilities required to meet NCQA requirements, DHCS-mandatedreports, and departmental strategic goals. Serves as an expert in Grievance & Appeals data.Presents findings to stakeholders to advance Partnership HealthPlan's operational excellenceand member experience. Will support the migration to a new Grievance & Appeals operatingplatform.

Develops quantitative analysis and programs reports to ensure Grievance & Appealsachieves NCQA requirements, DHCS-mandates, and departmental strategic goalsResponsible for the creation and submission of DHCS-mandated reports atdesignated frequenciesUsing data, identifies systemic issues that trigger member dissatisfaction. Makesrecommendations that improve operational excellence, member experience, and/orclinical practice to reduce grievance and/or appeals trendsAnalyzes and formalizes use of data for new Reporting Interest (RI) categoriesAnalyzes casework data and develops additional criteria for case-level identifiers thatwill further identify systemic issuesDefines and educates Grievance & Appeal staff on best practices for case-levelreportingCreates ad hoc reports upon requestsEstablishes an ongoing process to maintain quality data and define quality auditprocessesCreates and maintains the audit database of closed cases.Runs monthly Audit and Performance reports for Grievance & Appeals leadershipProvides data to leadership to support committee presentationsContributor to the Business Requirements Document (BRD), supporting the transitionto a new operating platform.Performs UAT. Submits IT Tickets as needed for Everest malfunctions or newdevelopment requests.Learns and retains business knowledge of Grievance & Appeals casework anddepartmental procedures.Knowledge of or has the aptitude to learn Microsoft Access, Advanced Excel,Microsoft SQL Server, Everest, Tableau.Leads projects or other activities as assigned

Education and ExperienceBachelor's degree or higher in Computer Science, Statistics, QualityControl, Quality Assurance, or related field preferred. Two(2) years quality administration related activities.Special Skills, Licenses and CertificationsDemonstrated aptitude for acquiring and applying technical skills in dataanalysis, reporting, and data systems. Critical thinker. Organized. Goodoral and written communication skills. Strong analytical skills includingknowledge of statistics. Excellent interpersonal skills. Ability to work withinan interdisciplinary structure and function independently in a fast-pacedenvironment while managing multiple priorities and meeting deadlines.Valid California driver's license and proof of current automobile insurancecompliant with PHC policy are required to operate a vehicle and travel forcompany business.Performance Based CompetenciesKnowledge of MS Excel, Access, SQL, Everest, Tableau and otheranalytic software. Demonstrated aptitude for acquiring new technical skillsin a data quality environment. Familiar with quality measurement andhealthcare data. Ability to communicate technical concepts with bothtechnical and non- technical individuals. Detail-oriented with goodorganizational and project management skills to work on multiple projectssimultaneously within established time frames. Works well under pressureand maintains a professional composure when interacting with allstakeholders.Work Environment And Physical DemandsStandard cubicle within a shared common area. Ability to use a computerwith standard software packages. More than 75% of work time is spent infront of a computer monitor. When required, ability to move, carry, or liftobjects weighing up to 25 lbs. - -All HealthPlan employees are expected to: -Provide the highest possible level of service to clients;Promote teamwork and cooperative effort among employees;Maintain safe practices; andAbide by the HealthPlan's policies and procedures, as they may from time to time be -IMPORTANT DISCLAIMER NOTICE -The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Keywords: Partnership HealthPlan of California, Fairfield , Reporting Analyst, Advertising , Fairfield, California

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