Job Description

1. Analytics and Reporting 

• Data Analysis: Analyze CPT-level data to identify trends, patterns, and insights relevant to healthcare services and payer rates. 

• Build and maintain analytical models for cost, quality, and utilization metrics, leveraging tools such as Python, R, or SQL-based BI tools. 

• Develop reports to communicate findings to stakeholders across the organization. 

2. 3rd-Party Data Management 

• Ingest and preprocess multiple 3rd party data from multiple sources and transform it into unified structures for analytics and reporting 

• Ensure compliance with transparency requirements and enable downstream analytics. 

• Design automated workflows to update and validate data, working closely with external vendors and technical teams. 

• Establish best practices for data quality checks (e.g., encounter completeness, claim-level validations) and troubleshooting. 

3. Data Integration and ETL Pipelines 

• Develop, maintain, and optimize end-to-end data pipelines, including ingestion, transformation, and loading of internal and external data sources. 

• Collaborate with Operations to design scalable, secure, and high-performing data workflows. 

• Implement best practices in data governance, version control, data security, and documentation. 

4. Quality Assurance and Compliance 

• Ensure data quality by implementing validation checks, audits, and anomaly detection frameworks. 

• Maintain compliance with HIPAA, HITECH, and other relevant healthcare regulations and data privacy requirements. 

• Participate in internal and external audits of data processes. 

5. Continuous Improvement & Thought Leadership 

• Stay current with industry trends, analytics tools, and regulatory changes affecting payer analytics. 

• Identify opportunities to enhance existing data processes, adopt new technologies, and promote data-driven culture within the organization. 

• Mentor junior analysts and share best practices in data analytics, reporting, and pipeline development. 

1. Education & Experience 

• Bachelor’s degree in health informatics, Data Science, Computer Science, Statistics, or a related field (master's degree a plus). 

• 1-2+ years of experience in healthcare analytics, payer operations, or related fields.

2. Technical Skills 

• Data Integration & ETL: Proficiency in building data pipelines using tools like SQL, Python, R, or ETL platforms (e.g., Talend, Airflow, or Data Factory). 

• Databases & Cloud: Experience working with relational databases (SQL Server, PostgreSQL) and cloud environments (AWS, Azure, GCP). 

• BI & Visualization: Familiarity with BI tools (Tableau, Power BI, Looker) for dashboard creation and data storytelling. 

• MRF, All Claims, & Definitive Healthcare Data: Hands-on experience (or strong familiarity) with healthcare transparency data sets, claims data ingestion strategies, and provider/facility-level data from 3rd-party sources like Definitive Healthcare. 

3. Healthcare Domain Expertise 

• Strong understanding of claims data structures (UB-04, CMS-1500), coding systems (ICD, CPT, HCPCS), and payer processes. 

• Knowledge of healthcare regulations (HIPAA, HITECH, transparency rules) and how they impact data sharing and management. 

4. Analytical & Problem-Solving Skills 

• Proven ability to synthesize large datasets, pinpoint issues, and recommend data-driven solutions. 

• Comfort with statistical analysis and predictive modeling using Python or R. 

5. Soft Skills 

• Excellent communication and presentation skills, with the ability to convey technical concepts to non-technical stakeholders. 

• Strong project management and organizational skills, with the ability to handle multiple tasks and meet deadlines. 

• Collaborative mindset and willingness to work cross-functionally to achieve shared objectives. 

• Advanced degrees (MBA, MPH, MS in Analytics, or similar). 

• Experience with healthcare cost transparency regulations and handling MRF data specifically for compliance. 

• Familiarity with DataOps or DevOps practices to automate and streamline data pipelines. 

• Certification in BI or data engineering (e.g., Microsoft Certified: Azure Data Engineer. 

• Experience establishing data stewardship programs & leading data governance initiatives. 

• Impactful Work – Play a key role in leveraging payer data to reduce costs, improve quality, and shape population health strategies. 

• Innovation – Collaborate on advanced analytics projects using state-of-the-art tools and platforms. 

• Growth Opportunity – Be part of an expanding analytics team where you can lead initiatives, mentor others, and deepen your healthcare data expertise. 

• Supportive Culture – Work in an environment that values open communication, knowledge sharing, and continuous learning.