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Consulting Services & Project/Program Management (Non-IT)

Driving Care Initiatives

From designing and leading complex programs to analyzing and translating business capabilities into powerful solutions, your expertise helps shape the future of health care.

Lead Advanced Analytics Consultant

Location: Rancho Cucamonga, CA Job Number: 936840 Date posted: 02/23/2021

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Description:
This role is responsible for analysis of healthcare related activity in support of strategic objectives. Researches related processing methodologies to ensure compliance with department/regional policy and procedures. May assist senior consultants or manage complex projects independently. The role may provide education and feedback to staff involved in the related processes and may lead discussions with external providers and/or customers to discuss issues and resolve discrepancies. The position may also play an advisory role with internal stakeholders to understand their business needs and how to translate these into technical solutions which support the development of analytics and reporting. Maintains and supports a culture of compliance, ethics and integrity. Maintains knowledge of policies and procedures and performs in accordance with the Principles of Responsibilities and applicable regulatory requirements, external laws and accreditation standards. Appropriately reports observed fraud or abuse.

Essential Responsibilities:
  • Analyzes information for accuracy according to established guidelines.
  • Performs analysis of healthcare data for the purpose of ongoing process improvement.
  • Creates data visualizations to support organization's strategic objectives.
  • Creates algorithms to extract information from large data sets.
  • Establishes scalable, efficient, automated processes for model development, model validation, model implementation and large-scale data analysis.
  • Designs research plans for data gathering & analysis; participates significantly in interpreting analyses & developing action plans accordingly.
  • Works with business partners to ensure accurate and effective coding required for data mining projects.
  • Researches industry best practices and provides reports as requested.
  • Communicates results/recommendations to project sponsors, clients, & various senior level audiences.
  • Ensures safeguarding of assets through the verification of documentation, approvals, & accurate coding of provider service & accounting data.
  • Partners with reporting team to create required operational and management reports.
  • Works collaboratively in a team environment with the ability to interact effectively with other groups in the organization.
  • Communicates with different levels of management regarding information needs. Ability to discuss these solutions with both technical and business community.
  • Develops and maintains appropriate documentation on all applicable projects.
  • Collaborates with development team on any issues involving systems architecture/structure of the data repositories, including development of new structures.
  • Interacts proactively with analysts and other users to define requirements and assess impacts to new or existing data structures, and communicates this in appropriate formats or documents.
  • Experience and understanding of relational and data warehouse environments.
  • Performs other duties as assigned.

  • Basic Qualifications:


    Experience



    • Minimum of six (6) years of experience in data science, process improvement, management consulting or related business experience.



    Education



    • Bachelor's degree in Science, Engineering, Technology or Math or related field required or four (4) years of experience in a directly related field.

    • High school diploma or General Educational Development (GED) required.



    License, Certification, Registration



    • N/A



     


    Additional Requirements:



    • Experience with data visualization and reporting tools (e.g., Tableau, Microsoft Power BI, QlikView, Microstrategy, etc.).

    • Experience with advanced analytics tools and languages (e.g., SAS, R, Python, Minitab).

    • Familiarity with database interfaces (e.g., Business Objects).

    • Knowledge of basic statistics and the ability to use and interpret statistical tools and techniques including but not limited to project charters, Process Mapping, SIPOC, capability analysis, cause and effect analysis, Gauge R&R, hypothesis testing, ANOVA, linear regression, designed experiments and statistical process control.

    • Experience with advanced analytical approaches including but not limited to logistic regression, time series forecasting, decision trees, classification models, neural networks, clustering, machine learning and other predictive analytical techniques.

    • Basic knowledge of process improvement methodologies (e.g., PMP, Six Sigma / Lean, etc.).

    • Knowledge of healthcare claims processes or other healthcare processes.

    • Demonstrated skills in data analysis and report generation.

    • Excellent mathematical, written and verbal skills and demonstrated medical terminology competence.

    • Ability to interact, collaborate and communicate with stakeholders at all levels within the organization including analysts, physicians and business leaders.

    • Demonstrated ability to think and act independently and professionally.



     


    Preferred Qualifications:



    • Minimum of nine (9) years of experience in process improvement, management consulting, Business Intelligence, data science, or related business experience preferred

    • Healthcare or insurance industry experience preferred

    • Degree in Technology, Engineering, Science, or Math or related field preferred

    • Business Intelligence and report development experience with SQL, Splunk, Tableau, Alteryx, etc.

    • Analysis and audit experience with large datasets

    • Experience with insurance claims

    • EPIC Tapestry experience

    • Experience implementing medium to large sized companywide initiatives

    • Opportunity analysis focusing on process optimization as it relates to claims intake, paper free initiatives, and member/provider interactions with claim related transactions

    • Process Monitoring and IT support as relates to Splunk and claim related transactions

    • Problem solving mindset with a focus on continuous improvement and learning new technologies

    • Ability to function as an internal consultant

    • Experience working with a diverse set of both technical and non-technical teams for requirements gathering, solutioning, and solution deployment

    • Experience with rapid prototyping and out of the box thinking

    • Knowledge of 835s, 837s, 277s, EDI/Paper claims, EOPs, EOBs, Medical Billing, Letters, and EFT transactions

    • Experience with Six Sigma process design and/or improvement methodologies and tools



    Primary Location: California,Rancho Cucamonga,Empire Corporate Plaza Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 AM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee Job Level: Team Leader/Supervisor Job Category: Consulting Services / Project/Program Management (Non IT) Department: Englewood MSSA Claims - National Claims Service Org - 0315 Travel: Yes, 5 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

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