Senior Decision Support Consultant

Company :
Highmark Inc.

Job Description : JOB SUMMARY

This position serves as a critical business-to-technical liaison, bridging the gap between business needs and the analytical technology team. The Senior Decision Support Consultant will leverage technical, analytical, and business expertise to design, develop, and support various complex projects and data analyses. A primary responsibility is to transform loose business language and high-level business needs into precise technical requirements, while also being capable of developing technical solutions.

The consultant will act as a senior resource within the team, fostering business-to-technical collaboration and providing strategic consultation directly to department leadership through engagement with business stakeholders. They will advise and consult on Enterprise Informatics strategy, business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization, and the use and planning of technology. The role involves executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding, mentoring, or providing senior-level oversight to lower-level analysts through all stages of project design and analysis.

The incumbent will utilize advanced technical skills, a deep understanding of core business units, their processes, and relevant data flows to prepare and analyze large, complex datasets, ensuring a robust analytical and financial analysis capability for Highmark's pharmacy and medical benefit specialty drug management programs. Furthermore, the incumbent will utilize advanced knowledge of corporate systems and data sources across Highmark's business units, coupled with a general understanding of data flows from various corporate systems (e.g., claims, billing, lab, and Rx), to solve complex issues and problems.

A comprehensive understanding of healthcare terminology, techniques, and reimbursement mechanisms, both within the healthcare industry and Highmark, is essential.

Provide insight into Enterprise Informatics analyses and provide consultative guidance to Highmark partners.

Key business contact throughout numerous business units that may assist in the resolution of issues or problems.

Access, review, utilize, contribute content to and participate in the maintenance of the shared Enterprise Informatics Intellectual Capital Repository to include but not limited to, review / editing of content submissions and best practices, audit reports, etc. The incumbent is expected to make major contributions to the Repository.

Performs Enterprise Informatics liaison advocacy for emerging areas of Highmark business and leads support liaison advocacy on behalf of selected Highmark business areas. Advocacy involves the representation of the business partner's critical business objectives when prioritizing new work requests vis-à-vis existing workload and resource commitments.

Provide overall technical direction (analytic and / or computing) of complex projects to creatively implement effective decision support applications and consultation on the design, testing, and enhancement of reporting systems. Recommends improvement to plan design.

Provides feedback to various areas in order to improve service delivery and enhance program design efforts.

Develop and foster relationships across Highmark and with professional organizations, user groups and industry trade groups to stay current with technology and analysis methods.

Work independently or leading a multidisciplinary team, designs and implement new analytic models and methodologies of a complex nature for profiling providers, assessing patient outcomes, studying cost and utilization trends and quantitative projections of industry and competitor performance, and conducting other general decision support activities.

Lead special complex studies, computer simulations, statistical testing and projects to solve unique problems / questions identified by middle / senior management, business partners, coalitions and governmental agencies. These studies and projects may involve all aspects of the health insurance business and care management processes and may be confidential in nature or for public dissemination.

Performs or leads staff in the development and maintenance of highly complex computer programs using 4GL programming languages and other advanced database / SQL technology, statistical modeling, system testing activities, lead initial problem identification and resolution activities, maintains program / system documentation and prepares / maintains operations documentation for assigned applications.

Utilize or lead the integration of data obtained from external sources such as HC4, HMS, Medco, Acxiom, NCQA, and BCBSA with internal Highmark data. This position routinely utilizes data including, but not limited to: medical / surgical physician and institutional claims and…