TRICARE Prime • Medicare Advantage • Medicare Part D • Health Care • Primary Care
4 days ago
TRICARE Prime • Medicare Advantage • Medicare Part D • Health Care • Primary Care
• Responsible for architecture, design, and development of key data infrastructure to support Health Plan wide activities including analytics and reporting, internal applications, data submissions, and operations related to risk score and revenue projections, CMS submissions, HEDIS data submissions, population health, etc. • Reviews database architectures and designs to ensure data integrity, quality, performance, and scalability; enforces data management best practices. • Collaborates with colleagues in the Health Plan and IT to jointly develop innovative data infrastructures that meets the evolving needs of the business. • Partners with the IT department to implement reliable solutions that are aligned with industry and MPHC standards. • Collaborates with key stakeholders to prioritize immediate ad-hoc tasks and future development efforts to ensure mature, reliable, and flexible infrastructure. • Collaborates with subject matter experts and end users in the design and development of appropriate solutions; translates end user or vendor requirements into practical data models. • Creates and maintains documentation of data processes, procedures, and definitions; upholds data governance standards and educates users of data. • Responsible for data integrity, maintenance, and troubleshooting of Risk Adjustment and HEDIS data. • Provides input on current and potential Risk Adjustment, HEDIS, and vendor activities as they relate to data, including extracts, transfers, submissions, and operational/reporting outputs. • Accountable for collaborating with vendor key technical contacts on internal or external solutions.
• Bachelor’s degree or equivalent combination of relevant education and experience. • 3 years of experience in data warehousing, including experience working with ETL processes, OLAP structures, SQL coding and dimensional modeling writing T-SQL code and procedures. • Experience with metadata management concepts, change management/version control concepts. • Experience with Healthcare and health insurance claims data preferred. • Experience with Risk Adjustment and HEDIS analytics highly preferred.
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