Senior Analyst, Medical Economics - Senior Analyst, Medical Economics (Trend Analytics, SQL, Power BI, Medicaid) - REMOTE
RemoteUnited States
Job Summary
Analyze claims, authorization, and data sources to identify trends in medical cost and utilization, then develop actionable recommendations for cost containment and financial performance. Execute pro forma sensitivity analyses to estimate the value of medical cost improvement initiatives and collaborate with clinical and provider network teams to design finance models for key performance indicators. Utilize SQL and Molina data warehouses to extract information for trend analysis, while building dashboards in Power BI and Excel to monitor health plan performance and root causes of cost drivers. Track scoreable action items and ROI analyses for vendors to ensure desired clinical and financial results, keeping abreast of Medicaid and Medicare reforms.
Required Qualifications
- At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.
- Bachelor's degree in statistics, mathematics, economics, computer science, health care management or related field.
- Demonstrated understanding of Medicaid and Medicare programs or other health care plans.
- 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.).
- Proficiency with retrieving specified information from data sources.
- Experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
- Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.).
- 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).
- Demonstrated 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.
- Understanding of value-based risk arrangements
- Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
- Ability to mine and manage information from large data sources.
- Demonstrated problem-solving skills.
- Strong critical-thinking and attention to detail.
- Ability to effectively collaborate with technical and non-technical stakeholders.
- Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
- Effective verbal and written communication skills.
- Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.
Desired Qualifications
- Proficiency with Power BI and/or Tableau for building dashboards.
- Proficiency in SQL and/or other programming languages with the ability to write, optimize, and execute complex queries to extract, analyze, and validate data.
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