Full-Time Senior Analyst, Medical Economics

• Extract and compile information from various systems to support executive decision-making
• Mine and manage information from large data sources.
• Analyze claims and other data sources to identify early signs of trends related to medical care costs.
• Work with clinical, provider network, and other personnel to bring context to data analyses.
• Design and perform studies related to the quantification of medical interventions.
• Perform pro forma sensitivity analyses to estimate the financial value of proposed medical cost improvement initiatives
• Proactively identify complex suspect areas regarding medical cost issues, and suggest a corrective action plan
• Draw actionable conclusions based on analyses performed, make recommendations through healthcare analytics, predictive modeling, and communicate those conclusions effectively
• Lead projects by contributing to ad-hoc data analyses, development, and presentation of financial reports
• Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes
• Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments
• Support Financial Analysis projects related to medical cost reduction initiatives
• Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors
• Keep abreast of Medicaid and Medicare reforms

• Required Education: Bachelor's Degree in Mathematics, Economics, Computer Science, Healthcare Management, or related field.
• Required Experience: 5+ years of related experience in healthcare
• Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans
• Analytical work experience within the healthcare industry
• Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)
• Proficiency with Excel and SQL for retrieving specified information from data sources.
• Experience with building dashboards in Excel, Power BI, and/or Tableau and data management
• Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
• Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form)
• Demonstrated understanding of key managed care concepts and provider reimbursement principles
• Understanding of value-based risk arrangements
• Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare
• Ability to mine and manage information from large data sources.
• Preferred Qualifications: Proficiency with Power BI and/or Tableau for building dashboards Experience with Databricks and TOAD Data Point

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