Sr Analyst, Medical Economics (hybrid)

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)

Requirements:

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.