Bachelor's degree in Business, Health Care Administration, Mathematics, Finance, Health Informatics, or related field.
4+ years of experience in a relevant field, preferably healthcare-related.
Master's degree in a relevant field preferred, substituting for 2 years of experience.
Proficient in Microsoft Office Suite, especially Excel, Word, and Access.
Experience with SQL queries and data visualization tools like Tableau or Qlikview is preferred.
Strong analytical, organizational, and problem-solving skills.
Familiarity with medical data structures (ICD10, CPT, HCPCS, NDC) and reimbursement models (DRG, APC, AWP+, Cost plus, PDGM).
Responsibilities
Consolidate monthly patient rosters from payers and distribute standardized lists to various departments.
Develop a monthly process to identify new and termed members, consolidating demographic details from multiple data systems.
Communicate with operational teams to fulfill their data and reporting needs.
Track business requirements from payers regarding cost reallocations and monitor case outcomes.
Create monthly processes for identifying candidates for potential cost reallocations and prepare necessary forms for payer submission.
Analyze data to identify opportunities for process improvement and execution enhancement.
Stay updated on current healthcare trends through literature and conferences.
Benefits
Opportunities for professional development and continuing education.
Access to industry conferences and seminars.
Collaborative work environment with cross-departmental interaction.
Potential for impactful contributions to business outcomes.
Engagement with current healthcare trends and practices.
Full Job Description
SUMMARY OF JOB DUTIES:
Senior Medical Economics Analyst will be responsible for working with Medicare Advantage and DCE membership files to produce panel reports, identify new and termed members, and other Medicare Advantage/DCE membership reporting.
ESSENTIAL JOB FUNCTIONS:
Consolidates monthly patient rosters from payers and disseminates standardized list to various departments (Value Based, Finance, Market Clinical Operations, etc.).
Develops monthly process to identify new and termed members and work across multiple data systems to consolidate demographic details.
Communicates with operational teams to meet their data and reporting needs.
Tracks business requirements from payers regarding cost reallocations and monitors case outcomes.
Develops monthly processes and procedures for identifying candidates for potential cost reallocations and completes accompanying forms, if applicable, for payer submission.
Obtain and analyze data to understand how to continually improve processes, procedures and execution.
Maintain knowledge of current healthcare trends by reading appropriate literature and attending related conferences and/or seminars.
Relied upon to apply business knowledge to analytics projects and provide value-added insights to directly impact business outcomes.
KNOWEDGE/SKILLS/ABILTIES:
Excellent written and verbal communication skills and ability.
Proficient in Microsoft Office such as Excel, Word, Access, etc.
Experience in writing SQL queries preferred.
Experience with using Tableau, Qlikview, or similar software preferred.
Strong analytical, organizational, and problem-solving skills.
Experience working with complex data sets across claims, lab, financial, clinical outcomes, and external sources.
Knowledge of medical data structures including, but not limited to (ICD10, CPT, HCPCS, NDC)
Knowledge of different reimbursement models (DRG, APC, AWP+, Cost plus, PDGM)
MINIMUM REQUIREMENTS
Bachelor's degree in Business, Health Care Administration, Mathematics, Finance, Health Informatics, or related field.
Requires 4+ years of experience; healthcare-related experience preferred.
Masters in relevant field preferred and can be substituted for 2 years' experience.
