Medical Economics Analyst Senior

Job Description

Researches and analyzes managed care data from various financial systems and interface tools. Performs complex and varied healthcare data analysis, including financial modeling and risk forecasting. Identifies and implements improvements in quality control and timeliness of reporting. Extracts, collects, analyzes, and interprets health utilization and financial data. Interprets and analyzes data from various sources using knowledge of healthcare managed care contracts and administrative claims data. Employs existing complex models and implements them on new projects and contexts. Designs new solutions for data and analytic challenges faced by the organization. Supports negotiations of capitated and other value-based agreements through detailed data analytics. Develops financial models to inform negotiation parameters. Evaluates possible changes to key terms in existing value-based agreements. Identifies risk and exposure associated with various reimbursement structures. Produces prospective analyses on new ventures, products, and service offerings. Prepares and presents analytics or project results to key stakeholders for review and decision-making. Evaluates and understands contract language related to reimbursement methodologies for various provider types. Applies detailed understanding of medical coding.

Knowledge, Skills, and Abilities

• Working knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation [Preferred]
• Working knowledge of population health, utilization measurement, and claims analytics [Preferred]
• Managed Care, Patient Financial services, health insurance claims processing, contract management, or medical economics [Required]
• Proficiency in understanding professional and facility claims and managed care concepts such as risk adjustment, capitation, FFS, DRG, APG, APCs and other payment mechanisms [Required]
• Experience in modeling financial impact of changes [Required]
• Strong ability to handle multiple projects including problem solving, research, analysis, and communication in a fast-paced environment [Required]
• Intermediate level of proficiency working with MS Excel including Formulas, calculations, charts, and graphs [Required]
• Strong skills in analytical/problem solving and presentations [Required]

Education

• Bachelor's [Required]
• Master's [Preferred]
• Field Of Study in Finance, Health Care Administration, Accounting, Mathematics, or Health and Informatics or related field in a related field

Work Experience

• 4+ experience performing data, financial and/or risk analytics in a healthcare environment [Preferred]

Additional Information

N/A

Physical Requirements

View physical requirements here

Pay Range

$66,170.74 - $123,073.07