Healthcare Analyst

Knowledge and Skills:

• Analyze performance under Medicare Advantage and other value-based contracts, including cost of care, utilization, quality metrics (e.g., STARs, HEDIS), and risk adjustment.
• Develop and maintain dashboards and reports using data visualization tools (e.g., Tableau, Power BI) to track KPIs across Innovacare’s primary care groups.
• Support clinical and care coordination teams with data on high-risk members, care gap closure, ER/SNF utilization, and chronic disease management.
• Assist in attribution reconciliation, performance forecasting, and incentive modeling in partnership with the contracting and finance teams.
• Monitor coding accuracy and documentation improvement opportunities to support accurate RAF (Risk Adjustment Factor) scores.
• Collaborate with IT and data engineering to improve data pipelines, ensure data integrity, and optimize reporting tools.
• Support payer reporting and compliance needs in accordance with CMS and state agency standards.
• Help prepare presentations for internal stakeholders and payers to report VBC performance and outcomes.

Technical Skills:

• Proficiency in SQL and Excel; ability to write queries and manipulate large datasets.
• Strong experience with Tableau, Power BI, or similar visualization platforms.
• Experience with Python or R for data analysis a plus.
• Understanding of medical coding (ICD-10, CPT) and healthcare claims structure.

Core Competencies:

• Strong analytical thinking and attention to detail.
• Ability to translate complex data into clear, actionable recommendations for clinical and business audiences.
• Strong communication and presentation skills.
• A self-starter who thrives in a fast-paced, evolving environment and is mission-driven.

Education:

• Bachelor’s degree in public health, Health Informatics, Biostatistics, Healthcare Administration, or related field required.
• Master’s degree (MPH, MHA, MS in Analytics or similar) preferred.

Qualifications:

• 2–5 years of experience in healthcare analytics, preferably within Medicare Advantage, Medicaid managed care, or value-based primary care.
• Experience working with claims, EMR, and clinical data, especially in risk-bearing organizations or MSOs.
• Familiarity with CMS risk adjustment models (HCC), RAF scoring, and VBC contract performance metrics.

The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.