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Business Analyst

Business Analyst

We support the network teams across the entire state for all providers (hospitals, physicians, ancillaries, etc.) and we’ve divided the state into 3 regions, north, southeast, and southwest. I am recruiting for someone to support the north region and here’s what that entails: 1. Supporting all requests from network staff a. Requests include pulling data for requests as easy as the number of trauma claims in Collin county to identifying ‘lookback’ claims where we need to tie the claim back to the original provider and determine outcomes, impacts, etc. b. Supporting negotiations with hospital providers thru development of our ‘negotiation package’ which is a 40 page document that includes everything you can imagine on utilization, cost, actuarial trends, etc. It’s a pretty in-depth component that is vital for our network teams to understand exactly what providers have provided in terms of services, market comparisons, etc. c. Creating and running queries off of our data warehouse (did I mention it’s the 4th largest dataset in the country? It is) which requires knowledge of SQL d. Identifying new report packages to be developed in Tableau 2. Subject matter expertise in your market a. This is a critical component and includes working with actuary to understand market trends which are driven by contractual increases, spend in certain acute and non-acute areas and other means of understanding what market forces are impacting results (freestanding emergency rooms are the latest health care evolution up here (north Texas) b. Presenting findings, either in person or via webex, on critical market issues c. Collaborating with others in network analytics (and other departments at BCBSTX) to further the ability to create new and improved analytic views d. Deep understanding and knowledge of critical providers in your market, in the north that would include Baylor, Christus, Cook Childrens and others. This knowledge includes understanding their stop loss provisions (if any) that exist in their agreement, contract terms (that may or may not be standard), and any other financial or clinical points that may or may not be responsible for driving their results..As for technical skills, a reasonable knowledge of SQL is necessary.