Healthcare Utilization Analytics Specialist

Kaiser Permanente; Downey (CA); On-site; USD 70,000 - 90,000; Full time

Job summary

Kaiser Permanente in Downey, California seeks a Utilization Analyst to coordinate and supervise data management, analyses and reporting for utilization management and related services, using computerized data systems and manual data as needed.

Responsibilities include collaborating with regional teams and outside facilities, reconciling billing, informing members and providers about benefits and charges, and maintaining data integrity under a Labor/Management Partnership environment.

Qualifications

• Experience applying analytic techniques and computer skills to hospital data.
• Strong analytic and verbal skills.
• Expertise with tracking, spreadsheets and graphic computer systems operating on PC mainframes.
• Knowledge of health plan benefits.
• Understanding of medical center operations, complex health systems, with the ability to quickly grasp regional policies, contract interpretation of out-of-plan medical services.
• Must be able to work in a Labor/Management Partnership environment.

Responsibilities

• Coordinates and supervises data and reporting needs, data collection process and data processing issues and provides timely utilization data and analytic support.
• Frequent contacts with other organizational units and outside facilities staff to obtain, verify and/or provide information, e.g., works with Regional Claims and outside hospitals to reconcile billing charges.
• Answers inquiries and educate patients, physicians and hospitals on covered benefits and charges.
• Provides information and assistance to Health Plan members during claims review process and coordinates authorized and non-authorized claims review.
• Documents outside medical services and reinforce procedures for patients seen in outside emergency department.
• May coordinate and supervise Air & Ground Transportation and Prospective Review Authorization Program.

Skills

Analytic techniques

Verbal skills

Health data experience

PC mainframes & spreadsheets

Health plan benefits knowledge

Education

High School Diploma or GED

Associate's or Bachelor's degree preferred

Tools

Mainframe

Job description

Kaiser Permanente in Downey, California seeks a Utilization Analyst to coordinate and supervise data management, analyses and reporting for utilization management and related services, using computerized data systems and manual data as needed.

Responsibilities include collaborating with regional teams and outside facilities, reconciling billing, informing members and providers about benefits and charges, and maintaining data integrity under a Labor/Management Partnership environment.