• Manager, Healthcare Informatics

    Location US-TX-Pearland
    Posted Date 4 months ago(8/7/2018 4:54 PM)
    Job ID
  • Overview

    Manager, Healthcare Informatics

    Location: Pearland Administrative Office

    Department: KS Plan Advantage

    Job Type: Full Time



    Kelsey-Seybold Clinic. Your Doctors for Life.

    Kelsey-Seybold Clinic is Houston’s premier multispecialty group practice, founded in 1949 by Dr. Mavis Kelsey.  With 19 clinic locations and more than 400 physicians, Kelsey-Seybold provides medical care in 55 medical specialties and is home to a nationally accredited Breast Diagnostic Center, Endoscopy Center, Infusion Center and Cancer Center.  Our mission is to provide our team members with exceptional opportunities for professional and personal growth.



    The Manager will serve as the Medicare Risk Adjustment and HEDIS subject matter expert and oversee a team of data analysts that provides data, systems support, and analysis for managing all financial aspects of risk adjustment and quality reporting. The team operates the CMS Encounter Data and HEDIS vendor software solutions and implements reporting and analysis specific to Medicare risk adjustment, RAPS, EDPS and HEDIS. The team analyzes and researches all encounter data errors and issues, collaborating with internal departments to work toward error resolution. The team is responsible for calculating and analyzing member-level risk scores and provides data and analytical support to the HCC Coding team who conduct medical record review.

    This position will have responsibility for managing the data, workflows, and applications used in the CMS Encounter Data, RAPS, and HEDIS submissions and analysis and will be responsible for leading projects and engaging collaboration within Finance, IT, Claims and Enrollment areas to optimize risk adjustment and quality reporting results. This position will also support analysis related to maximizing star ratings from CMS and quality measure reporting for commercial employers. The position will review and apply all related regulatory requirements related to department activities including: CMS audits, changes in risk adjustment models, changes in submission requirements, HEDIS data validation, etc.


    Key responsibilities of this position include:

    • Developing, producing, and analyzing reports and data required to understand the key drivers of the relevant business unit or service line

    • Managing recurring activities to ensure timely and accurate payment and reporting and compliance with government or private payer reporting requirements

    • Providing pricing support for provider group and Medicare Advantage plan

    Participating as a key member in strategy discussions and meetings with the KS executive team, third party payers, and employers




    (A = basics; B = preferred) 



    Bachelor’s Degree in Finance, Economics, Mathematics, Healthcare Administration, or related field


    MBA or MHA preferred



    • 7+ years of experience in data analysis, decision support, medical economics, healthcare informatics, or managed healthcare

    • 3 + years of experience supervising or managing teams and/or projects

    • Demonstrated initiative and problem solving skills

    • Demonstrated ability to create and implement analysis/modeling that converts raw data into actionable business insights

    • Demonstrated ability to analyze and report on business units, products or service lines with minimal supervision/direction



    • Experience in the healthcare industry and familiarity with healthcare systems (e.g., enrollment/eligibility, capitation, claims payment, etc.) with a Managed Care Organization (MCO)

    • Knowledge of medical insurance products and basic underwriting concepts

    • Experience with Medicare Part C or Health Insurance Marketplaces highly desirable, particularly with CMS risk adjustment models

    • Experience in the healthcare industry with understanding of data in healthcare organizations (including claims data, ANSI 5010 837 data specifications, ICD10, Medicare Advantage, Health Insurance Marketplace, capitated payment models)








    Special   Skills



    • Advanced proficiency in Microsoft Excel

    • Basic knowledge of Microsoft Power Point and Microsoft Word

    • 3+ years of programming experience in SQL, SAS or similar application language

    • Experience writing, debugging and documenting complex queries against relational databases

    • Experience participating in/leading system design and implementation initiatives


    • Experience with Statistical Software (including SAS, R, Minitab, SPSS)

    • Experience with reporting tools (including Crystal Reports and Microsoft Access)

    • Familiarity with EPIC and Clarity reporting data warehouse




    • Fluent in English both verbal and written, effective communicator

    • High level of accuracy with excellent attention detail

    • Strong organizational and time management skills

    • Proven ability to work in a dynamic setting and balance multiple priorities while meeting deadlines

    • Superior analytical skills

    • Ability to communicate complex information in a clear and concise manner

    • Ability to motivate others and function as a working manager








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