Senior Analyst, Medical Economics - UM Analytics (Remote)

Overview

This role provides senior-level analyst support for medical economics and health care analytics activities. Responsibilities include extracting, analyzing, and synthesizing data from multiple sources to identify risks and opportunities, improve financial performance, and support decision-making across the enterprise.

Responsibilities

• Extract, compile, and manage data and information from multiple systems to support executive decision-making.
• Mine and manage information from large data sources.
• Analyze authorization data for utilization management analytics, including understanding the relationship between authorization and claims, utilization management reporting metrics, and utilization metric outcome interpretation.
• Analyze authorization, claims, and other data sources to identify early signs of trends or other issues related to medical care costs.
• Analyze financial performance, including cost, utilization, and revenue across all health plan products—identify favorable and unfavorable trends, develop recommendations, and communicate findings to leadership.
• Draw actionable conclusions from analyses using health care analytics and predictive modeling; communicate conclusions effectively to audiences at various levels.
• Perform pro forma sensitivity analyses to estimate the expected financial value of proposed medical cost improvement initiatives.
• Collaborate with clinical, provider network, and other teams to provide context for data analyses and design and perform studies to quantify medical interventions.
• Partner with business owners to track key performance indicators related to medical interventions.
• Proactively identify and investigate complex suspect areas related to medical cost issues, conduct in-depth analysis, and suggest corrective action plans.
• Design and develop reports to monitor health plan performance and identify root causes of medical cost trends; drive innovation through creation of tools to monitor trend drivers and recommend affordability opportunities to senior leaders.
• Lead projects to completion by contributing to ad-hoc data analyses and the development and presentation of financial reports.
• Serve as a subject matter expert in developing financial models to evaluate the impact of provider reimbursement changes.
• Provide data-driven analytics to finance, claims, medical management, network, and other departments to enable critical decision-making.
• Support financial analysis projects related to medical cost reduction initiatives.
• Support medical management by assisting with return on investment (ROI) analyses for vendors to determine whether financial and clinical performance is achieving desired results.
• Stay current on Medicaid and Medicare reforms and their impact on the business.
• Support scoreable action item (SAI) initiative tracking to performance.

Requirements

• At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.
• Expert in SQL coding through any platform; job requires writing code daily for data mining, understanding table relationships, and auditing for outcome accuracy.
• Bachelor’s degree in statistics, mathematics, economics, computer science, health care management, or related field.
• Demonstrated understanding of Medicaid and Medicare programs or other health care plans.
• Analytical work experience within the health care industry (e.g., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.).
• Proficiency retrieving specified information from data sources.
• Experience building dashboards in Excel, Power BI, and/or Tableau and managing data.
• Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) with proficiency in utilization management.
• Knowledge of health care financial terms (e.g., PMPM, revenue) and standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) used in medical coding/billing (UB04/1500 form).
• Demonstrated understanding of key managed care concepts and provider reimbursement principles including risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
• Understanding of value-based risk arrangements.
• Experience quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
• Ability to mine and manage information from large data sources.
• Demonstrated problem-solving skills.
• Strong critical-thinking skills and attention to detail.
• Ability to collaborate effectively with technical and non-technical stakeholders.
• Strong time-management skills; able to manage simultaneous projects and tasks to meet internal deadlines.
• Teachable attitude with curiosity for the business and analytics.
• Effective verbal and written communication skills.
• Proficient in the Microsoft Office suite; strong Excel skills (VLOOKUPs and pivot tables) and proficiency with applicable software.

Preferred Qualifications

• Proficiency with Power BI and/or Tableau for building dashboards.

Compensation & Benefits

• Pay Range: $59,810.6 - $129,589.63 / ANNUAL
• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Location

• Not specified in the posting.