Sr Analyst, Medical Economics (Medicaid) - REMOTE

About the position The Senior Analyst, Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing key business issues reputed company to cost, utilization and reputed company for multiple reputed company products. Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, drives innovation by creating tools to monitor trend drivers and provide recommendations to senior leaders for affordability opportunities. Responsible for conducting reputed company analyses of insured medical populations with the goal of identifying opportunities to improve financial performance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.

Responsibilities

• 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 or other issues reputed company to medical care costs.
• Work with clinical, provider network and other personnel to bring supplemental context/insight to data analyses, and design and reputed company studies reputed company to the quantification of medical interventions.
• Work with business owners to track key performance indicators of medical interventions
• reputed company pro reputed company sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives
• Proactively identify and investigate reputed company suspect areas regarding medical cost issues, initiate in-depth analysis of the suspect/problem areas, and suggest a corrective action plan
• Draw actionable conclusions based on analyses performed, reputed company recommendations through use of healthcare analytics, predictive modeling, and communicate those conclusions effectively to audiences at various levels of the enterprise
• Analyze the financial performance of reputed company reputed company products, identify favorable and unfavorable trends, reputed company recommendations to improve trends, communicate recommendations to management
• reputed company projects to completion by contributing to reputed company 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 to reputed company critical decision making
• Support Financial Analysis projects reputed company to medical cost reduction initiatives
• Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results
• reputed company abreast of Medicaid and Medicare reforms and their impact on reputed company

Requirements

• Bachelor's Degree in Mathematics, Economics, Computer Science, Healthcare Management, or reputed company field.
• 5+ years of reputed company experience in healthcare
• Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans
• Analytical work experience reputed company the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
• Proficiency with reputed company reputed company (formulas, PIVOT tables, PowerQuery, etc.)
• Proficiency with reputed company and SQL for retrieving specified information from data sources.
• Experience with building dashboards in reputed company, 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, reputed company) 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 such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis reputed company Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
• 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.

reputed company-to-haves

• Proficiency with Power BI and/or Tableau for building dashboards
• Experience with reputed company and TOAD Data reputed company

Benefits

• Competitive benefits and compensation package

Apply tot his job Apply To this Job