Medical Informatics Analyst, Principal

Your Role 

The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Prior Authorization Medical Informatics Analyst, Principal will report to the Sr. Manager, HQA Analytics. Your focus will be in helping us strategize the prior authorization approach and applying rigor around the data analysis needed to make those decisions. The output of this analysis will be reported to several internal and external organizations.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work 
In this role, you will:

• Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California (BSC) strategic goals
• Work cross-functionally to develop reporting for end-to-end prior authorization. This includes Network Management, Medical Management, and Claims and Pharmacy 
• Collaborate closely with the Prior Authorization Program Manager and recommend strategic action for improving performance and commitments 
• Develop strong, strategic partnership with internal and external stakeholders
• Utilize and recommend enhancements to existing self-service reporting solutions
• Develop and maintain data driven strategy and operational reporting processes in support of the BSC prior authorization function
• Analyze data, build control reporting, and communicate changes to all levels of the BSC enterprise
• Understand the data structures and sources, and the use of analytical or statistical tools to create meaningful insights that drive strategic action and results
• Design, develop, and maintain interactive dashboards and data visualizations using Tableau and Power BI to support business insights and decision-making

Your Knowledge and Experience

• Requires a college degree or equivalent experience 
• Requires 10 years of prior relevant experience in Health Care (managed care, academic, or government payer)
• Requires SAS Certified Base Programmer Credential or equivalent
• Requires SAS Certified Advanced Programmer Credential or equivalent
• Requires mastery level knowledge of health data science typically obtained through advanced education combined with experience.  May have deep knowledge of project management
• Ability to function independently and produce results that meet standards of quality, timeliness, and acceptability
• Problem-solving skills balanced between “analytical” and “intuitive” 
• Ability to thrive in ambiguous situations
• Excellent verbal and written communication skills and the ability to interact professionally with a diverse group of executives, directors, managers, and subject matter experts
• Ability to establish and maintain effective and collaborative relationships with key stakeholders
• Advanced skills using Microsoft Excel, Word, Visio, and PowerPoint in preparing and making presentations to various levels of management.  Proficient at using MS Project
• Technically proficient (having broad background) in problem solving tools
• Knowledge of Blue Shield of California (BSC) or similar health care organization structure
• Extensive knowledge of CPT, HCPCS, ICD-10s and other related industry codes

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.