Job description

Summary:

The Medical Economics Analyst will be responsible for supporting strategic and operational initiatives through healthcare data analytics and financial modeling for the managed care department. The Medical Economics Analyst is responsible for collecting , analyzing and interpreting healthcare data information to solve business problems.

Must Haves:

• Bachelors in Finance or related field
• 5 years plus experience required in MANAGED CARE, health care pricing, medical economics or related discipline
• Creating and using financial modeling tools, spreadsheets, and business intelligence tools to perform financial impact analysis and data manipulation
• Extensive knowledge of healthcare/medical economics data such as hospital/physician /ASC claims, utilization data, various payment methodologies, various types of fee schedules(such as CMS) and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APCs.
• Advanced proficiency working with business intelligence tools which include Tableau and MS Excel
• Extensive experience working with large databases and complex data sets and be able to identify data gaps and make reasonable assumptions where necessary to summarize data.

Detailed responsibilities:

• Perform strategic pricing analysis to support the negotiations and implementation of appropriate reimbursement rates for managed care contracting initiatives. This includes modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. The role will also provide pricing recommendations to optimize reimbursement.

• Develop complex analytics for value based agreements. This includes financial and quality performance metrics, identify opportunities and propose changes to the reimbursement models and risk arrangements. This includes ACO/shared savings, bundle payments, transplant and other risk arrangements.

• Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by the negotiators including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes. Analyze terms of new and existing risk and non-risk contracts and/or amendments/modifications using approved model contract language.

• Prepare complex service line reimbursement analysis and financial performance analysis using a broad spectrum of healthcare data. Develop methods and models (involving multiple variables and assumptions) to identify the implications of a wide variety of new/revised strategies, approaches, provisions, and rate structures aimed at establishing appropriate reimbursement levels.

• Key stakeholder in multiple high profile cross functional pricing, strategic or operational projects. This role provides both healthcare analytical support and subject matter expertise as it relates to the managed care book of business.

• Manages the detailed analysis, design, coding, testing, implementation and maintenance of reports, dashboards, and other delivery methods used to support managed care business analytics.

• Responsible for managing and maintaining contract pricing software for contract modeling and accounts receivable pricing. This includes fee schedule updates, architecture updates, testing and validation to ensure accurate pricing/posting of contractual allowances.

• Stay up-to-date of changing healthcare landscape to maintain an awareness of competitor services and reimbursement models, as well as opportunities for improvement of the financial components of managed care contracts.

Job Type: Full-time

Pay: $90,000.00 - $110,000.00 per year

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

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