Medical Services Analyst

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Responsible for researching, auditing and analyzing advanced to highly complex level of data to develop new and/or enhanced reports/reporting mechanism/process system flows in support of strategic operational planning. Identifies trends and/or recommends business solutions, interprets and develops standard policies, procedures and guidelines for clinical operations departments such as Pharmacy and Clinical Research.
Analyzes data to identify variation in the way medical/pharmaceutical services are delivered at HealthCare Partners and to better understand the reasons for this variation.
Carries out assigned analyses comparing alternative ways of delivering medical services in order to determine the most cost-effective way of providing various medical and/or pharmaceutical services.
Assists in the monitoring of HCP financial performance including injectable spending, comparison of projected pharmacy spending vs. actuals, generic utilization tracking by plan, OTC metric for PPI's and NSA's and rebate reporting.
Assists in the monitoring of regional financial performance including generic utilization, OTC program metric, targeted TC market share reporting, Medicare fee schedule updates.
Provides support to member outreach programs including OTC and TC outreach initiatives.
Assists in the evaluation of costs and outcomes of various programs designed to improve the delivery of medical/pharmacy services.
REQUIREMENTS
1 or 2 years of post-high school education or a degree from a two-year college.
Over 1 year and up to and including 3 years of experience.
Computer literate.
Fluent in PC applications.
Knowledge of Microsoft software (Word, Excel, PwoerPoint, Access).
Effective verbal and written communication skills.