Program Integrity Reporting Analyst

AmeriHealth Caritas in Philadelphia, PA

  • Industry: Information Technology - Software Engineer, Developer, And Programmer
  • Type: Full Time
  • $78,745.00 - 139,760.00
position filled
**Program Integrity Reporting Analyst**



Location: Philadelphia, PA



Telecommuter?: No



ID**: 17751



**Job Brief**



Develop and maintain reports such as: technical reports, ad-hoc reports, CORS data reports and various internal and external dashboards.



Your career starts now. We're looking for the next generation of health care leaders.



At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.



Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .



**Responsibilities:**



+ Under the supervision of the Manager of Program Integrity Recovery and Reporting, and in support of the data reporting function, serve as SME concerning Program Integrity operations, vendor\subcontractor activities and Plan-specific service requirements to develop and produce various reports and analysis that support Program Integrity objectives.

+ Develop and maintain various types of programmatic reports such as: technical reports, ad-hoc reports, CORS data reports and various internal and external dashboards.

+ Provide data analysis and assist in developing reporting methodologies for tracking recovery and savings trends, including potential fraud and abuse trends, in areas such as: overpayment prevention, quality improvement, provider contracting, financial savings and cost reductions, and statutory requirements.

+ Work with management, operations units, stakeholders and the reporting staff to prepare clear, sound, timely, accurate and informative statistical and narrative reports containing findings, analysis, conclusions, and recommendations.



**Accountabilities:**



+ Collaborate with Manager, Program Integrity (PI) Associates, and Associates at all levels of the enterprise, as required, to define reporting objectives and implement meaningful, effective, efficient, repeatable, and scalable solutions.

+ Gain in-depth familiarity with PI processes, workflows, MIS functionality, reports database(s) and data element definitions to identify best and most appropriate data extraction sources, methodologies and categories for report development.

+ Analysis of all current PI reports and making recommendations for enhancements to same - such as introducing automated data extraction to ensure consistency in data reporting over time.

+ Identify and implement efficiency gains in terms of report production, distribution, and scalability to accommodate growth while ensuring reports are repeatable.

+ Improve upon existing PI reports and develop new scheduled and ad-hoc reports as directed, such as project inventory, savings dashboards, daily\weekly\monthly vendor activity monitoring tools, Plan- and State-specific reporting, weekly tagged claims files, and special one-time extracts and tables, upon request.

+ Create spreadsheets and/or report tables to track internal and vendor\subcontractor performance in various specified categories, upon request.

+ Format results into visually effective tools - including objects such as graphs and charts, etc. - using standard tools such as SAS, SQL, ACFC Business Intelligence tools, Tableau and to a lesser degree MS Access, Excel, PowerPoint, Visio, etc.

+ Research, test and validate data results for accuracy. Perform effective and consistent QA of all reports before distributing for consumption.

+ Maintain a library of available PI reports - including an archive for historical report storage and retrieval. Define, document and maintain report requirements, development methodology and essential reporting records and file documentation for all reports developed and or enhanced. Maintain the report archive, including the formal requirements, addendums, updates, calendar of due date(s) and distribution lists of such reports.

+ Analyze data and reporting aberrations and provide written explanations for variances and recommended changes.

+ Identify emerging trends and potentially important issues and report on them accordingly.

+ Prepare clear, sound, accurate, timely and informative statistical and narrative analytical reports containing findings, analysis, conclusions, and recommendations.

+ Extract and manipulate large data files.

+ Extract and summarize data from a variety of systems, such as Facets, data warehouses and other computer databases, used for measurement and decision support.

+ Performs other related duties and projects as assigned.

+ Adheres to AmeriHealth Caritas policies and procedures.



**Education/Experience:**



+ Bachelor's Degree or equivalent

+ Minimum one to three years data analysis and reporting experience required

+ Minimum one to three years of SQL or other related query development experience

+ Excellent verbal and written communication skills

+ Strong analytical, conceptual and problem-solving skills to evaluate complex business reporting requirements and to translate these into value-added solutions.

+ Proven ability to manage multiple concurrent tasks\projects

+ Strong work ethic, self-motivated, self-initiated learner

+ SAS Enterprise Guide, Tableau, Microsoft Access, Excel

+ Experience supporting or writing reports, business correspondence and technical documents required

+ Experience gathering requirements and documenting specifications required

+ Experience in driving projects from initiation through to completion, and in being an accountable party for results

+ Experience working in a team setting and on assigned project teams as required



EOE Minorities/Females/Protected Veterans/Disabled
Associated topics: administrative, administrative assist, assistant, executive assistant, intern, office assistant, operational assist, operational support, operator, production

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