Medical Economics Analyst Sr – Hybrid Position Available In Orange, Florida

Medical Economics Analyst Sr – Hybrid
Maitland, FL
AdventHealth Corporate

Job Schedule:

Full-time

Pay Range:

$31.81 – $59.17 per hour

Job ID:

25012373

Job Family:

Managed Care

Shift:

1 – Day
Facilities
Benefits
Hiring Process
Hospitals, medical centers and facilities need more than physicians, nurses and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady and experienced team working behind the scenes to make sure communities around the country receive the health care they need.
If you’ve also been interested in working in the health care field but aren’t a health care provider, a corporate career at AdventHealth may just be the perfect fit. We’re a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.
Start your journey with a health care career at AdventHealth Corporate.
Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we’re committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.
All the benefits and perks you need for you and your family:
Benefits from Day One
Paid Days Off from Day One
Student Loan Repayment Program
Career Development
Whole Person Wellbeing Resources
Mental Health Resources and Support

Schedule:

Hybrid – 3 days at the office (Altamonte Springs, FL)
The role you’ll contribute:
A Senior Medical Economics analyst is responsible for analyzing and evaluating financial and economic data related to healthcare costs and managed care payer rates and reimbursement. The role focuses on financial trends, reimbursement methodology, data tools, modeling, and managing revenue. Must be able to complete extensive and complex financial and operational analyses of managed care contracts and proposals, analyze fee schedules, and determine contract compliance. The Senior Medical Economics analyst must have attention to detail and competencies in decision support and reporting through converting raw data into meaningful applications to support executive decision making.
Character traits to include: Strong work ethic, trainability, communicative, team player, and strong analytical skills
The Senior Medical Economics Analyst will work with managed care staff for both in the Florida and Multi-State Divisions of AdventHealth, as well as represent AdventhHealth managed care to payers in all AdventHealth Markets.
The value you’ll bring to the team:
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 an 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
Demonstrates proficiency with various reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge
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, ley 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 AdventHealth 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
The expertise and experiences you’ll need to succeed :
Minimum Education Requirements
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
Minimum Experience Requirements
Minimum of four (4) years’ experience performing data, financial and/or risk analytics in a healthcare environment
Working knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation strongly preferred
Working knowledge of population health, utilization measurement, and claims analytics strongly preferred.
Managed Care, Patient Financial services, health insurance claims processing, contract management, or medical economics required
Proficiency in understanding professional and facility claims and managed care concepts such as risk adjustment, capitation, FFS, DRG, APG, APCs and other payment mechanisms
Experience in modeling financial impact of changes
Strong ability to handle multiple projects including problem solving, research, analysis, and communication in a fast-paced environment
Intermediate level of proficiency working with MS Excel including Formulas, calculations, charts, and graphs
Strong skills in analytical/problem solving and presentations required

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED

Epic HB Certification required or must be obtained within first 6 months of hire
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category:

Managed Care

Organization:

AdventHealth Corporate

Schedule:

Full-time

Shift:

1 – Day

Req ID:

25012373
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.
Internal Employees Apply Here
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.