HMSA Senior Business Analyst — Medicare/Medicaid Financial Performance Job in Honolulu, HI


Employment Type:


Exempt or Non-Exempt:


Job Summary:


Focused on HMSA’s Government Programs plans (e.g. Medicare and Medicaid-related), extracts data from multiple internal and external sources, provides statistical, financial, and business analysis to help HMSA manage the Medicare and Medicaid line of business financial performance and cost of health care, such as evaluating quality improvement initiatives, the effectiveness of various health programs, population health improvements, and clinical outcomes that initiate action or change.

Functions independently and serve as a senior level subject matter expert on the performance management functions for HMSA’s Government Program plans. Leads projects and represents the department on organizational projects.

Minimum Qualifications:

  • Bachelor’s degree and four (4) years of related experience, or an equivalent combination of education and related work experience.
  • Strong working knowledge of the techniques used to present statistical data.
  • Effective analytical skills to evaluate data reliability, determine appropriate statistical models, correlate factors and organize data.
  • Strong written and verbal communication skills.
  • Organization and time management skills to work on multiple projects simultaneously and meet project deadlines.
  • Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.

Duties and Responsibilities:

Research and Analysis:

  • Conduct research, uses algorithms and specific skills in quality improvement, medical statistics and financing and applies sound knowledge of statistical theory and its application to research methodology.
  • Reconciles internal information related to risk scores and anticipated revenue, membership, and classification of HMSA’s membership with CMS and QUEST information, either directly or through oversight of other departments, to assure that HMSA is receiving proper credit and payment for all Government-related plans.
  • Primarily responsible for data analysis from various sources to provide statistical data for financial modeling, quality improvement research and reporting for physicians and providing actionable data and reports to improve cost and quality of care. Ensures feasibility and evaluates reliability of data source information, conducts analysis of statistical data sets, interprets statistics and identifies significant relationships, and organizes results into a compatible and useful format to prepare conclusions and forecasts based on data summaries.
  • Researches and identifies opportunities in performance of line of business such as RAPS/EDPS data submission accuracy, reducing error rates in LIS, MSP, or other indicators that impact premiums and develops action plans for recommendation.
  • Analyzes claims data information and utilizes predictive algorithms to develop recommendations regarding interventions for health services programs.
  • Develops reporting tools and maintains various database programs, including financial and clinical data, to analyze, track, review and support a variety of medical management activities.

Applications and Data Analysis:

  • Responsible for design, analysis, development, integration, maintenance and support of specific internal applications related to data analysis.
  • Completion of existing risk adjustment processes, workflows and programs.
  • Takes primary lead on testing efforts of new or modified applications for department.
  • Analyzes existing applications and/or designs new computing services or systems to complete data analyses and reporting required to meet changing goals.
  • Evaluate system options, make recommendations, provides input and technical guidance. Develops necessary project plans for implementation to lead and coordinate problem tracking, resolution, and verification testing, as needed.

Project Management and Administration:

  • Provides leadership to critical technology projects to assure data analysis and reporting capabilities are incorporated and available.
  • Utilize project management techniques to document and coordinate activities to ensure deliverables are met.
  • Perform cost/benefit analysis that supports business operations and project management. Assist to define solutions that support business flows through use of workflow design/redesign.
  • Monitor, evaluate, interpret and disseminate program requirements related to risk adjustment activities. Ensure activities are conducted in accordance with applicable standards, line of business controls and requirements. Develop methods to improve daily operations and practice standards.
  • Collaborates and works with external customers and clients (primarily physicians and clinic administrators) to evaluate business needs.

Reports and Presentations:

  • Analyze/create derived results, translates data, and creates analytical presentations using tables, graphs, charts, written report or other methods.
  • Produces written project and study reports in a structured and informative manner.
  • Ensure reports and presentations are accurate, concise, clearly stated and appropriate for internal and external audiences and all levels of staff.
  • Collaborates and works with external customers and clients (primarily physicians and clinic administrators) to evaluate business needs.
  • Design reports to deliver data and information that will address and improve business needs.


Other Duties/Functions:

  • Perform all other miscellaneous responsibilities and duties as assigned or directed.

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