Medical Economics Analyst

ESSENTIAL FUNCTIONS

• Leads or participates in complex medical economic projects (e.g. medical cost savings trend and risk assessment initiatives) including identification and completion of key deliverables.
• Apply statistical analysis methods to develop validate and execute algorithms statistical models and reporting tools that answer applied research and business questions for internal and external clients.
• Provide medical cost trend analytics assess variance to expectations and determine forecasted contract terms for health insurer and risk bearing provider clients.
• Makes recommendations about data collection methods metrics definition and evaluation methods.
• Develops studies analyses and presentation materials needed to appropriately inform decision makers. Presents results and recommendations to management across VBC teams.
• Works cross-functionally throughout the organization toward achieving operational targets.
• Presents complex information in a way that multiple levels within an organization can understand and utilize to make appropriate decisions to meet business objectives.
• Responsible for project commitments to quality and on-time deliverables.
• Willingness to understand and probe into technical details.
• Creates and evaluates the data needs of assigned projects and assures the integrity of the data.
• Works independently to plan and conduct sophisticated analyses.

EDUCATION AND PROFESSIONAL

• Bachelors degree required

EXPERIENCE

• Functional Information Management/Analyzes all types of capitated and fee-for-service provider contracts; performs medical cost trend and variance analysis; identifies medical cost management opportunities - 2-4 years relevant experience
• Functional Information Management/Provides analysis and using claims and eligibility data - 2-4 years relevant experience
• Functional Information Management/Statistical and data model design - 2-4 years relevant experience
• Functional Information Management/Claim lag and IBNR analysis- 1-2 years relevant experience
• Functional - Products-Medicare Commercial Medicare Advantage and Medicaid Plans - 2-4 Years relevant experience
• Functional - Information Management/Medical Economics analysis and reporting - 2-4 Years relevant experience
• Technical - Database/SQL Server or other - 2-4 Years relevant experience
• Technical - Reporting Tools/Power BI or similar - 2-4 Years relevant experience
• Technical - Desktop Tools/ Microsoft Excel; Word; PowerPoint; Access - 2-4 Years Relevant experience

REQUIREMENTS

• Undergraduate degree in math/actuarial business finance or related field preferred;
• 3 years of work experience in the health insurance value based care or healthcare administration industry.
• 2 years experience with database management systems such as SQL Server DB2 or SAS
• Proficiency in performing data analytics using health care claims data
• Proficiency in statistical methods of data analysis
• Experience with actuarial analyses and methods preferred but not required
• Understanding of medical cost drivers and provider reimbursement methodologies.
• Strong problem solving analytical and project management skills.
• Demonstrated extensive and diverse knowledge of health care data metrics systems and standards; demonstrated subject matter expert in multiple subject areas.
• Ability to make sound decisions and recommendations to drive business solutions.
• Ability to communicate statistical and technical ideas and results to non-technical clients
• Ability to work independently and complete projects within established timeframes
• Self-starter and ability to juggle competing priorities

SKILLS

• General Business/Demonstrating Business and Industry Acumen - ADVANCED
• General Business/Turning Data into Information - MASTERY
• Finance/Delivering Profit and Performance - MASTERY

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment or remote
• Some travel within the community.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching are required.
• Manual dexterity using a computer keyboard phone and scanner.

ORGANIZATIONAL REQUIREMENT

• HOPCo Mission Vision and Values must be read and signed.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities knowledge skills abilities and working conditions may change as needs evolve.

Required Experience:

IC