Using Health Plan Client Medical and Pharmacy claims as input, perform complex analysis to provide valued information to specialty pharmacy account teams and clients. Investigate key drivers of benefit/physician/drug performance and proposes changes to improve performance, delivery or management. Access performance of the healthcare levers, processes, and controls in place, to manage specialty drug delivery and then provide recommendations for Fairview Specialty Pharmacy and its Payer clients for improvements.
Lead development/creation and completion of highly-complex analysis to validate, support, and/or report the value provided by Fairview Specialty Pharmacy products, services and initiatives. This will be accomplished by the development/creation of new reports, analytical models, and tools, which may include items to be packaged and offered as new products to Fairviews clients.
Leads the development of analytic methodologies, models, reports and/or new products.
Manipulate large sets of medical and pharmacy data to achieve desired results.
Create new queries using SASEG including multiple table joins, understanding of table structures, creation of detailed lengthy formulas, basic understanding of SAS code.
Create complex formulas (nested statements) and be able to manipulate data using SAS, SPSS, SQL, and Microsoft Access, Excel and/or other analysis tools.
Analyzes and interprets client pharmacy and medical benefit data and reports.
Act as a champion of specialty analytic methodologies and mentor team members on best
practices related to analysis, report creation and/or presentation.
Using data analysis to identify new ways to do things that enhance performance, results and outcomes.
Responds with information available at hand; has consultative style with internal and external clients.
Consults with and present results of analyses to account management teams and clients.
Articulate industry trends to clients and the impact of trends and changes to the client financials.
Provides recommendations to the Specialty account team and payer clients based on knowledge of the business and drivers of the metrics.
Assume ownership role in responsibility for success of client analytics and ad hoc reporting.
Leads and guides complex client analytical work and serves as a knowledge expert for other analysts.
Four year college degree in healthcare, mathematics, economics, science or finance Masters degree in math, statistics, computer science, or Public Health or related field with training qualitative analysis and research methods
4-6 years of work experience in pharmacy benefits management, benefits consulting, health care, or medical field where the candidate is literally performing analysis on raw Medical and/or Pharmacy claims to create various deliverables
Experience conducting financial and/or data analyses, reporting, and forecasting using Medical and/or Pharmacy claims.
Advanced/significant hands-on statistical software programming experience (e.g. STATA, SPSS, or SAS/SASEG) analyzing large administrative claims databases (e.g. over 5 million records), including at least of the following:
4-6 Years SAS EG/SAS
Experience with MS SQL Server or other relational database/s, including SAS
Experience with managing and manipulating large sets of claims data.
Proficient in Microsoft Office, with advanced proficiency in Excel
4-6 years experience working in the specialty pharmacy area, both pharmacy and medical benefit knowledge and experience is preferred. Knowledge of specialty pharmacy and medical metrics and clinical quality measures, with critical thinking skills to apply variations of methods based on business needs
Experience working in a hospital, health system, pharmacy, or provider practice setting is preferred.
Hands-on familiarity with administrative claims data and standard medical/pharmacy coding schemes (e.g. ICD-9, HCPCS, and CPT-4)
Demonstrated success in analytic or healthcare related consulting engagements.
Requires demonstrated analytic skills and creativity to quickly integrate information and develop proposals for new analytic initiatives. Demonstrate curiosity and determination in pursuing complex and innovative approaches to data needs. Progressive experience and leadership in clinical analytics in healthcare environment is essential.
Strong written and verbal communication skills are needed, including the ability to "translate" analytic concepts, approaches and results for executive or lay audiences, including clinicians, and analytic interpersonal skills with an ability to communicate to small and/or large audiences (both internal and external).
Experience in communicating to a senior management audience and ability to drive consensus on complex, controversial issues.
Ability and preference to work in a team environment.
Demonstrated problem solving and organizational skills, with strong attention to detail
Ability to manage multiple, diverse projects in a fast-paced environment with tight deadlines
Competency with Microsoft office application and Access
Ability to apply strong knowledge related to financial levers of a Specialty Pharmacy and/or industry standards/trends, in support of recommendations and business case development
Advanced troubleshooting skills, including in-depth client data research, which may involve research and drivers of utilization. Understands resources needed and steps/processes on how to complete the problem. When an issue arises, able to understand how to navigate to a resolution.
Ability to understand and address the complexities of integrating medical and pharmacy data
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, ...Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.