Medical Health Economics Analyst, Full-Time, Days

Responsibilities

• Research and analyzes managed care data from the various financial systems and interface tools.
• Performs analysis of complex and varied healthcare data including financial modeling and risk forecasting.
• Work to identify/implement improvements in quality control/timeliness of reporting.
• Extracts, collects, analyzes and interprets health utilization and financial data of various types.
• Interpret an analyze data from various sources using knowledge of healthcare managed care contracts and healthcare administrative claims data.
• Employs existing complex models and implements them on new projects and/or new contexts and she/he designs new solutions for data and analytic challenges the organization faces.
• Support the negotiations of capitated and other VBA agreements between physicians/hospitals and payers/networks through detailed data analytics.
• Develop financial models and inform VBA negotiations parameters and evaluate possible changes to key terms in existing value-based agreements.
• Identify risk/exposure associated with various reimbursement structures.
• Produce prospective analyses in new venture, products, and service offerings.
• Prepare and effectively present analytics or project results to key stakeholders for review and decision-making.
• Evaluate and understand contract language as it relates to reimbursement methodologies for the full spectrum of app provider types.
• Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II, DRG and revenue codes.
• Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators.
• Ad-hoc reporting, management and intelligence related to large claimants, sequestration and healthcare exchange programs.
• Accumulates data in logical format, interprets results, makes recommendations and influences outcomes.
• Prepares well-organized project-specific documentation, that includes at a minimum, analytic methods used, key decision points and caveats with sufficient detail to support comprehension and replication.
• Leads in the development and review of the annual Managed care net revenue budgets to support the annual budget process.
• Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance.
• Demonstrates independent thinking and creativity in development of contract models, standard reports and ad hoc analyses.
• Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by leadership.
• Maintains a high degree of accuracy while using large amounts of data.
• Participates in special projects and performs other duties as assigned.

Qualifications

• Generally, requires 3 to 5 years of related experience.
• Bachelor's degree in finance, Health Care Administration, Accounting, Mathematics, or Health and Informatics or related field required.
• Master's Degree in a related field preferred.