Job Description:
As a Medical Economics Analyst, you'll play a key role in supporting our company's healthcare analytics efforts for various value-based contracts. Your main tasks involve collecting, analyzing, and presenting insights from electronic health records, payer portals, and reports to tackle complex healthcare challenges. Your analysis will cover healthcare cost trends, individual patient data, and more, serving as a crucial resource for executive management, physicians, and internal/external clients. Additionally, you'll ensure compliance with reporting specifications from government agencies and other entities.
Responsibilities:
- Generate and deliver reports on medical cost and utilization.
- Analyze member enrollment history and medical claims data, focusing on diagnoses and procedures.
- Investigate reasons for high claims costs, including medical coding and provider details.
- Liaise with leadership regarding financial transactions like kick-payments and stop loss recoveries.
- Test and validate the impact of updates before incorporating them into reimbursement calculations.
- Collaborate with teams to develop best practices for identifying and addressing data discrepancies.
- Design and maintain managed care monitoring reports, incorporating industry best practices.
- Ensure accuracy and efficiency in report distribution to management and internal stakeholders.
- Work closely with management to analyze reporting and clinical data, providing insights for customer proposals.
- Create financial reports and clinical analyses for care coordination staff, physicians, and executives.
- Participate in project teams, analyzing new programs or ventures that require clinical or financial data analysis.
- Prepare and present reports, presentations, and other materials in meetings.
- Identify problematic areas and conduct research to propose corrective actions.
- Stay updated on relevant healthcare initiatives and regulations.
- Interpret data and communicate business insights to non-technical users.
- Monitor capitated specialties for cost-saving opportunities and critical changes.
- Analyze medical encounters and revenue cycles for cost-saving opportunities.
Education/Experience:
- Bachelor's degree in Business Administration, Healthcare Administration, or related field required.
- MBA, MPH, MHA, or advanced degree preferred.
- Minimum of 2 years' experience in healthcare, insurance, consulting, or data analytics.
- Familiarity with Electronic Medical Records and population management systems preferred.
- Experience in healthcare or value-based modeling is advantageous.
- Proficiency in data analytics or visualization tools (e.g., Excel, SQL, SAS, Tableau, Statistical Modeling) preferred.