Become a part of our caring community and help us put health first
 

The Value Based Programs Lead generates ad hoc reports and regular datasets and/or report information for end-users using queries and scripts to inform value-based payment (VBP) model design and administration. The Data and Reporting Sr. Professional integrates data from multiple sources to produce requested or required data elements. Programs and maintains report forms and formats, information dashboards, data generators, canned reports and other end-user platforms. May create specifications for reports based on business requests. Collaborates with leaders to make decisions on complex issues regarding job duties and related tasks. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Key Responsibilities

• Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
• Scorecard creation and reconciliation of provider performance based on contractual terms.
• Analyze utilization data to reconcile provider disputes.
• Design and develop provider reporting packages to help providers understand their overall performance.
• Partner with finance team to conduct impact analysis and modeling for new VBP models.
• Collaborate with cross functional and matrixed teams to operationalize and rollout new VBP models.
• Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
• Design Return on Investment (ROI) Analyses for new Value Based Payments (VBP) using multiple data sources, including prior authorizations, healthcare claims, Admit/Discharge/Transfer (ADT) data, HEDIS data, etc.
• Creation of data models to attribute members to providers for new value based programs and to evaluate program effectiveness
• Ensure data integrity in program administration for new value based programs
• Troubleshoot data integrity issues and offer solutions to solve challenges

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree
• Minimum 5 years of technical experience in data reporting having advanced Microsoft Excel skills including ability to link pivots to external data sources, creating pivot tables and summarizing data into reports and dashboards
• Experience in Medicaid and/or Medicare managed care
• Experience working with big and complex data sets within healthcare organizations
• Progressed experience in SQL, SAS and other data systems
• Proficiency in verbal and written communication to leadership
• Strong organizational skills and ability to manage multiple or competing priorities
• Strong analytical and problem solving skills
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Strong attention to detail
• Experience in Medicaid and Medicaid managed care
• Experience in a system analytics and/or data warehousing environment

Preferred Qualifications

• Masters Degree
• Experience performing claims data analysis to inform VBP model design
• Advanced experience in SQL, SAS and other data systems
• Experience with tools for creating data visualizations

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$95,300 – $131,200 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.