Sup IHS Analysis & Reporting

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Job Summary

This Position Is Responsible For Overseeing The Production And Development Of Utilization And Cost Containment Information. Oversees The Analysis And Preparation Of Outcomes Using Healthcare Claims Data. Participates In The Development Of Data Reports And/Or Products To Meet Contract, Production, And Quality Standards, To Ensure That Quality And Timeliness Contract Standards Are Met Or Exceeded; Ensuring Customer Satisfaction; And Supporting Needs Of The Department. This Position Also Provides Leadership To The Analysis And Reporting Team Through Workload Management, And Technical Support.

• Oversees the production and development of financial reports to support Indian Health Services. This may include, but is not limited to the Headquarters monthly financial information (billed, MLR savings, and paid dollars) and financial reports used by IHS to develop their budget.• Oversees the production and development of utilization reports to support Indian Health Services. This may include, but not limited to, the Area Executive Summaries (amount of dollars spent per type of service; cancer treatments, injuries and death based on diagnosis/procedure/revenue codes) and DRG Analysis reports.• Understanding of information received on all types of claims, including how data relate to each other, in order to accurately define report parameters, make recommendations to customer, and accurately analyze results. This includes understanding the revenue/CPT codes, DRG codes and Medicare reimbursement methodologies.• Understanding of contract requirements; ensure adherence to requirements; devise standards for measurement, and establish/maintain monitoring tools. Monitor report timeliness to ensure contract standard for ad-hoc reporting is met or exceeded and contract report deliverables are provided in a timely manner.• Clearly and precisely communicate with Headquarters, Area Offices, Service Units and Tribes on complex report requirements and/or issues that require definition, resolution, clarification, or further investigation. Work with the customer to define and document ad hoc report parameters and set reasonable deadlines for report delivery to ensure accuracy and timeliness. • Design, implement, and analyze process improvements for customer satisfaction by following up with customers; answering customer questions; analyzing and interpreting customer requests; and communicating customer needs to staff.• Certify external report requests to ensure report requirement have been met and the data is within expected norms. If necessary, develop code to validate the report results.• Maintain and manage the CMS reports (PSF and cost reports) that support pricing of claims. Manage the University of New Mexico Hospital (UNMH) cost settlement process, used by IHS to determine costs owed by IHS to UNMH.• Maintain, guide, and develop staff by providing training in new procedures and problem solving; establish goals; answer questions; provide information, educational opportunities, and growth opportunities; plan, monitor, and appraise performance; interview, select, and train employees; and counsel/discipline employees.• Foster a spirit of cooperation and teamwork; communicate/coordinate requirements with staff; establish time frames and priorities; resolve problems; manage workload; review/assess performance of direct staff; maintain expenditures within budget; and motivate staff to excel their performance in order to exceed customer expectations.• Manage distribution and medical review clerks to ensure accurate processing of outgoing correspondence and medical records requests. • Manage team and processes to ensure compliance with contract and/or internal requirements for documentation, record retention, timeliness, and accuracy.• Design and program complex systems and coordinate and/or complete assignments regarding those systems, including working with users to develop and maintain application design, i.e. Microsoft Access.• Responsible for all aspects of a project, which includes defining, planning, developing, coding, debugging, testing, documenting and analyzing results.• Understanding of the Software Development Lifecycle and Configuration Management processes.• Assist in evaluating workflow and develop recommendations to enhance efficiency within the department

Preference in filling vacancies is given to qualified Indian candidates in accordance with the Indian Preference Act of 1934 (title 25, USC Section 472)

Native American Indian Preference shall apply to this position pursuant to the Indian Self-Determination and Education Assistance Act (24 U.S.C. 450, et seq.), 25 CFR 271.44 and other relevant laws (title 25, U.S. code, Section 472 & 473)

JOB REQUIREMENTS:

• Bachelor Degree and 4 years experience, including 3 years experience in health care data analysis and reporting, accounting, and/or computer programming. Work experience can be substituted for Degree.
• 3 years experience in programming.
• 2 years experience in a leadership position, including project management.
• 1 year experience in Information Reporting or Financial Analysis.
• Planning, organizational and project management skills.
• Analytical skills and ability to identify problems, make recommendations, and implement solutions, including technical solutions based on business case findings.
• Ability to work under pressure and meet deadlines.
• Interpersonal skills, including ability to work in a team environment, facilitate teams, support consensus decisions, display flexibility, present a professional and knowledgeable image, and act with diplomacy.
• Verbal and written communication skills.
• Ability to travel, including some overnight stays

PREFFERE JOB QUALIFICATIONS:

• SAS experience
• SQL experience
• Knowledge of Medicare payment methodology

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HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.