Join a progressive organization that is leading the way in the public sector. The Human Resources Department is seeking a Health Care Analyst to join our team.  
 
In this position, you will help manage the county’s health and wellness program by measuring its effectiveness and financial performance against established goals and benchmarks. You will collaborate with the county’s benefits consultant, third party administrator and many other vendors in an effort to meet multi-year program objectives.
 

• Implement health program design changes or modified service offerings to remove any racial disparities with respect to access or utilization or gaps in needed care. 
• Analyze medical, pharmacy, dental, flexible spending account and vision claims reporting, score cards and vendor performance results for evaluating against goals and standards.
• Evaluate and monitor member ability to navigate the health care delivery system across plans, networks and vendors.
• Maintain program compliance with respect to ACA, HIPPA, COBRA, Internal Revenue Code and other federal and state laws.
• Manage the services received from the benefits consultant, claims administrator, pharmacy benefits manager and other vendors, to optimize the value of these relationships and ensure deliverables are timely met.
• Oversee the process for administering health program claim appeals, consistent with the plan document, administrative rules, plan summaries and applicable laws and regulations.
• Assemble and direct health program content e.g., health education, health consumerism training or holistic health tools needed for proper engagement in maintaining good health or prevention of chronic conditions.

• One of the following:
  • Bachelor's degree or higher in organization development, business administration, industrial relations, human resources administration, public administration, psychology or a field closely related to the position and three or more years of experience managing health programs including design, communication, administration, reporting and compliance, sponsored by a large organization. 
  • Certificate in human resources from an approved college or university and five or more years of experience managing health programs including design, communication, administration, reporting and compliance, sponsored by a large organization.
  • Two years of college including 12 semester credits in the above fields and five or more years of experience managing health programs including design, communication, administration, reporting and compliance, sponsored by a large organization. 
  • Seven or more years of experience managing health programs including design, communication, administration, reporting and compliance, sponsored by a large organization. 

• Experience:
  • Successfully managing a self-insured health care program.
  • Working with healthcare claims, electronic health records, ICD-10 codes, National Committee for Quality Assurance (NCQA) health plan accreditation and Healthcare Effectiveness Data and Information Set (HEDIS) measures across care domains.
  • With relational databases and data warehouses and business intelligence tools for health claims analytics.
• A certificate in Employee Benefit Specialist (CEBS), Public Health Regulations (PHR), Senior Professional in Human Resources (SPHR) or other related certifications.
• Knowledge of:
  • The health care industry, including market trends, scope of services offered by carriers, plans and other providers.
  • The rules, regulations and laws enforced by federal and state agencies that apply to self-insured group health, pharmacy and dental plans.
  • The rules, regulations and laws enforced by federal and state agencies that apply to flexible spending account plans and insured vision care plans.
  • Value-based health care program design and health care consumer tools/reference pricing.
• Ability to:
  • Solve complex problems and issues, using creativity, organization knowledge and independent judgment.
  • Direct quantitative analysis methodologies of health care data to identify sources of claims trend, correlate to causal or related factors and develop actionable insights.
  • Analyze, interpret and summarize health care information from public domain research, benchmark, partner and internal data sources.
  • Lead without authority and influence others, develop strong working relationships and deliver results and or expertise in a professional manner.