Medical Economics Analyst

About the Role

Key Responsibilities

• Assisting in research and analyzing managed care data from various financial systems and interface tools.
• Assisting in analysis of complex healthcare data including financial modeling and risk forecasting.
• Working to identify and implement improvements in quality control and timeliness of reporting.
• Working with Senior Medical Economics Analyst to extract, collect, analyze, and interpret health utilization and financial data.
• Assisting in interpreting analyzed data from various sources using knowledge of healthcare managed care contracts and administrative claims data.
• Identifying risk/exposure associated with reimbursement structures and producing prospective analyses for new ventures, products, and services.
• Performing analysis of healthcare data including financial modeling.
• Evaluating contract language related to reimbursement methodologies.
• Demonstrating proficiency with reimbursement methodologies such as Per Diem, DRG, fee schedules, and percent of charge.
• Assisting in ad-hoc reporting related to large claimants, sequestration, and healthcare exchange programs.
• Preparing project-specific documentation with analytic methods used.
• Supporting the development of annual managed care net revenue budgets for Florida and Multi-State Divisions.
• Evaluating contract performance against expectations and analyzing data to recognize trends.
• Participating in multiple projects within a fast-paced environment and maintaining high accuracy with large data sets.
• Participating in special projects and performing other duties as assigned.

Requirements

• Bachelor's degree in Finance, Health Care Administration, Accounting, Mathematics, or Health and Informatics or related field (Preferred).
• At least 2 years of related experience.
• Working knowledge of value-based arrangements including shared savings, bundled payments, pay-for-performance, and capitation.
• Knowledge of population health, utilization measurement, and claims analytics.
• Experience in Managed Care, Patient Financial services, health insurance claims processing, contract management, or medical economics.
• Proficiency in understanding professional and facility claims and managed care concepts such as risk adjustment, capitation, FFS, DRG, APG, APCs, and other payment mechanisms.
• Strong ability to handle multiple projects, including problem solving, research, analysis, and communication in a fast-paced environment.
• Beginner/Intermediate proficiency in MS Excel, including formulas, calculations, charts, and graphs.

Nice to Have

• Experience with financial modeling and risk forecasting.
• Knowledge of healthcare administrative claims data and reimbursement methodologies.

Qualifications

• Bachelor's degree in a related field (preferred).
• 2+ years of relevant experience.

Benefits & Perks

• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support