RESPONSIBLE FOR :
- Develops new reports, dashboards and other means to enable transparency and to monitor network management operational processes and to provide timely information to senior management regarding status of compliance with guidelines, rules/regulations and internal policies and procedures and to assist with decision-making and tracking accountability.
- Identifies indicators and interprets statistical data to detect, correct and prevent situations that may negatively impact the department’s performance or compliance requirements.
- Determines the mechanisms for obtaining data on the use, clinical and demographic that is required internally and externally for analysis (programs, systems, etc.)
- Monitors data quality and consistency and creates reports to proactively address and resolve data quality violations.
- Manages projects related to obtaining providers related data, analysis and interpretation.
- Coordinates plans and executes the reporting of data for the industry of health insurance, Blue Cross Blue Shield Association, Department of health, HEDIS and others.
- Develops systems of accumulation of data and evaluation methods to be able to report any indicator that has to do with utilization and expenditure at different levels of the company.
- Produces and analyzes comparative statistical reports for internal and external data and identify trends, patterns, or fluctuations, and recommends future action for the Corporation.
- Tracks trends reflected in the data and the outcome of the recommendations accepted by the Corporation.
- Coordinates with other areas to obtain requested data when it is not readily available.
- Participates and collaborates on internal and external audits, in the division’s processes automation, corporate and divisional projects, and other similar tasks.
- Responds to Ad hoc reporting requests by creating reports as needed for specific situations, such as other departments, auditors and external regulators.
- Understands key network strategic initiatives and collaborate where appropriate to achieve strategic results.
- Collaborates with cross-functional team to ensure compliance and quality requirements are met per local and federal laws and regulations and other agencies as applicable.