Location: Remote, Connecticut US
Job Number 3497
Remote, Connecticut US
JOB SUMMARY:Responsible for developing tactical and strategic
recommendations for optimization of profitability, clinical
performance, member and provider satisfaction, and client
satisfaction by leveraging analytic tools, financial models and
reports. Conducts and manages analysis based on claims, provider,
member, group and related provider data to derive new knowledge
from operational, financial and clinical provider databases. Will
organize, lead and support efforts to measure, analyze and report
on trends enterprise-wide related to the utilization,
reimbursements, access to care, cost management, and other
high-level metrics to identify and promote strategies to positively
influence access to quality, cost and improved program performance.
It also works with other areas of the company, including
Underwriting, Clinical Management, and Client & Provider Engagement
to assist in the understanding of program cost and network trends
impacting profitability and to recommend strategies for improvement
wherever possible.PRIMARY JOB RESPONSIBILITIES:
Responsible for the tactical and strategic partnership with the
network team in identifying, interpreting, prioritizing, designing
and procuring analyses to help guide business decisions.
Responsible for partnering with business and clinical teams and
other internal clients and resources to enable and execute
impactful, accurate business analytics.
Develop and maintain a deep understanding of financial
performance metrics with an eye toward identifying and addressing
areas of opportunity or risk.
Develop a strong understanding of analytical tools and models to
provide analysis of client and provider data.
Lead analytical projects and coordinate with other team members,
including programmers to deliver on internal client needs.
Analyze current cost management practices and help to define
best practices for: o Outcomes measurement o Provider optimization
o Benefit structures and algorithms o System edits, outlier trends,
UM and UR o Member behavior management
Monitor and track provider reimbursements to identify strategies
to ensure access and profitability targets are met in a manner that
is consistent with quality, cost-effective care.
Work with other internal departments as necessary to develop
strategies and programs to manage dental costs within each market
to assure profitability and budgetary goals.
Provide mentoring and support to internal business partners to
increase their overall understanding of cost analysis and therefore
increase the business partners' ability to make independent
Utilize Microsoft Office products to prepare client-friendly
materials that comprehensively represent cost provider data.
Provide recommendations on policies, objectives, and
Evaluate and suggest changes as necessary to optimize processes
Participate in special projects as needed or requested.
Analyze leased network provider data (Dentemax, Careington,
Other), as well as DCP provider data.
Evaluate partnership network provider data (UHC, Other,
Provider fee provider data - all o Net effective discount calc o
Fair Health provider data o By product: Medicaid, Medicare
Advantage, CHP, Exchange, D2C, EPO, PPO
Collect provider data for use in RFP provider data/Bid provider
data analysis and prep.
Other duties as needed or required.
Bachelor's degree in Computer Science, Math, Finance or
5 years' experience in complex provider data management,
analysis and reporting to include experience with combining
clinical and financial provider data.
Demonstrated project and client management expertise.
Expert at presenting complex analytic methodology,
interpretation, and recommendations to diverse senior-level
audiences through visual, verbal and written deliverables.
Expert at identifying appropriate analytic approaches to solve
broad business challenges.
Experience with provider database and business intelligence
Strong experience in statistical methods and concepts
Demonstrated ability to analyze, solve and interpret complex
Knowledge of provider reimbursement methodologies.
Excellent PC skills with proficiency in MS Office products
(Excel, Access, Word, PowerPoint) are essential.
Strong customer service and analytical skills.
Strong project management and process improvement skills.
Ability to lead and work well with others.
Ability to prioritize and organize multiple tasks and remain
focused with multiple interruptions.
Ability to meet multiple deadlines.
Comprehensive understanding of business management, research
and/or economics is required.
Knowledge of health care industry
Incumbent must be able to communicate effectively.
Requires overall light physical effort (up to 25lbs.).
Manual dexterity and sitting are required in carrying out the
position's own position responsibilities (i.e. use of a personal
Ability to travel or move about within and outside serviced
Incumbent works primarily in either a private or shared office
Webelieve that everyone should live life free of dental disease.
As a purpose-driven, double bottom line company that is improving
oral health for everyone, we are transforming the oral health
system - from the way we provide care and pay for it, to how we
talk about it and prioritize it in our policies and
Meaningful change requires a revolution in oral health. We are
redefining what it means to prevent disease and provide better
access to care for everyone. We are going beyond the dental chair
to reshape the oral health system, addressing total health and the
social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach
and insights to advance policy, financing, care, and the community.
That means solving problems in a flexible and efficient way,
testing and trialing to create new solutions and
deliveringmeasurableoutcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work
together with passion, perseverance and focus to achieve a nation
where no child suffers from the pain of tooth decay. Where adults
keep all their teeth for their entire lives. Where every person has
access to quality dental care.
DentaQuest 465 Medford Street Boston, Massachusetts