AVP, Medical Economics - REMOTE
RemoteUnited States
Job Summary
Lead strategy and team oversight for medical economics analysis, extracting and synthesizing data to identify risks, opportunities, and performance improvements. Manage the medical economics function, including SAI analytics, governance, and trend mitigation, while recruiting, mentoring, and developing professionals. Collaborate with health plans to develop scoreable action item tracking tools and implement companywide governance processes. Drive staff in KPI reporting, vendor proposal reviews, and best practices across payment integrity, national contracting, and clinical programs. Ensure delivery of project plans, required reporting, and data management initiatives to support executive decision-making and financial outcomes.
Required Qualifications
- At least 10 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience
- At least 5 years management/leadership experience
- Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field
- Advanced understanding of Medicaid and Medicare programs or other health care plans
- Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
- Advanced proficiency with retrieving specified information from data sources
- Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management
- Advanced knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
- Advanced knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form)
- Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms
- Advanced understanding of value-based risk arrangements
- Advanced experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care
- Advanced problem-solving skills
- Advanced critical-thinking and attention to detail
- Ability to effectively collaborate with technical and non-technical stakeholders, and engage with various levels within the organization
- Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines
- Excellent verbal and written communication skills
- Proficient in Microsoft Office suite products, advanced skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency
Desired Qualifications
- Experience in complex managed care
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