Aetna Informatics Consultant in Blue Bell, Pennsylvania
Req ID: 48944BR
Telework Options Available for this opportunity
This position is located in the National Quality Management, Quality Reporting department, and will be working as a member of a team that is responsible for implementing a new measure framework solution for the successful reporting of 40 existing and 6 new provider performance measures. Post- implementation, this team will be responsible for the ongoing maintenance, enhancements, and support of the quarterly measure runs. Provider performance measures are a key component of Value Based Contracting for Accountable Care Organizations and other strategic networks. Measure outcomes impact provider value based incentive reimbursements and plan sponsor payments.
Perform research and analysis, including writing sql queries to identify the logic needed to update existing measure specifications and create new measure specifications.
Identify logic and create specifications for provider attribution and benchmarking criteria.
Translate the business requirements defined in the measure specifications for developers.
Analyze measure results to confirm validity and perform complex root cause analysis to identify issues.
Create solutions and specification updates as needed to resolve issues with measure results.
These activities require advanced technical, analytic and consultative skills, as well as an extensive knowledge of health care data and information systems.
Seven or more years of relevant analytic experience.
Five or more years of experience with health care membership and claims data.
Advanced SQL programming expertise in a data warehouse or big data analytics environment, including the ability to use any type of ad-hoc query tool to execute SQL.
Experience in working in a data warehouse environment as well as the ability to work with large data sets from multiple data sources.
Experience with HEDIS or other healthcare industry standard performance measures.
Knowledge of medical record coding (ICD10 diagnosis and procedure, CPT4, and HCPCS).
Strong problem solving skills and critical thinking ability.
Demonstrated project management and/or team lead experience.
Able to make sound decisions and recommendations to drive business solutions.
Ability to communicate statistical and technical ideas and results to non-technical clients in written and verbal form.
Strong collaboration and communication skills within and across teams.
Understanding of relational databases, data systems and data warehouses.
Strong reporting skills using Excel, Access, and/or Tableau.
Understanding of customers strategies, information needs programs, processes and products.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Information Management/Informatics/5
Functional - Information Management/Applied research and statistical analysis/5
Functional - Information Management/Data acquisition, data management, programming and documentation/5
Technical - Development Languages/SQL/7-10 Years/
Technical - Reporting Tools/SAS/1-3 Years/
Technical - Database//7-10 Years/
General Business/Turning Data into Information/ADVANCED
General Business/Consulting for Solutions/FOUNDATION
General Business/Ensuring Project Discipline/FOUNDATION
General Business/Applying Reasoned Judgment/FOUNDATION
Telework is considered for current internal teleworkers working in Eastern or Central Standard Time Zone
ADDITIONAL JOB INFORMATION
This position offers an excellent opportunity to become an industry expert in the area of performance measurement in a Hadoop / big data environment.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care