Medical Economics Consultant

Role Overview

The Medical Economics Consultant position reports to the Manager of Medical Economics and Business Processes within Actuarial Analytics. This position is primarily responsible for developing large reporting layers, reports, executive decks, and enhanced metrics for our Total Cost of Care (TCOC) revenue and expense review process.

Responsibilities

• Meeting the business on needs for actionability from insight by helping develop High-Value Opportunities (HVOs) that are in the millions of dollars in savings/revenue added & validating ongoing initiative savings methodology & accounting
• Consultants have technical backgrounds and will create tools and reports that draw on disparate datasets and follow departmental infrastructure and practices to generate a complete picture of our medical expense and revenue trends, primarily Medicaid by member cohort and claim category, through the use of industry-standard KPI
• Work with operational matrix partners to understand business processes in place to ensure reporting relevancy and present findings to leadership clearly and concisely
• Technology competencies include Azure Databricks, MS SQL Server, MS Power BI, Excel Data Models, or equivalent technologies

Requirements

• Bachelor’s Degree in Actuarial Science, Economics, Computer Science, IT, IS, or a related field strongly preferred OR equivalent combination of education and work experience will be considered
• One to three (1 – 3) years of experience working in Medical Informatics, Medical Economics, or related analytical positions at Managed Care Organizations, vendors, or providers
• Strong knowledge of health informatics terminology & classification schemes, i.e., CPT codes, ICD-10 dx, common groupers like DRGs, CCS, etc
• Strong knowledge of industry-standard population health & quality KPIs, i.e., utilization per thousand, readmission rates, HEDIS metrics, PMPM, and Cost per Unit
• Understanding of enterprise approaches to either MS SQL Server & related RDBMS technologies or MS Azure & related cloud computing data lake solutions; Mastery of SQL
• Strong knowledge of the anatomy of healthcare claims and/or encounters
• Strong knowledge of Excel
• Excellent communication skills

Qualifications

A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Skills

• Technical backgrounds in Medical Informatics, Medical Economics, or related analytical positions
• Ability to work with disparate datasets and follow departmental infrastructure and practices
• Knowledge of health informatics terminology & classification schemes, i.e., CPT codes, ICD-10 dx, common groupers like DRGs, CCS, etc
• Knowledge of industry-standard population health & quality KPIs, i.e., utilization per thousand, readmission rates, HEDIS metrics, PMPM, and Cost per Unit
• Mastery of SQL
• Strong knowledge of the anatomy of healthcare claims and/or encounters
• Excel proficiency

Benefits

• Flexible work solutions including remote options, hybrid work schedules
• Competitive pay
• Paid time off including holidays and volunteer events
• Health insurance coverage for you and your dependents on Day 1
• Tuition reimbursement