Medical Economics Analyst

Presbyterian is seeking a Medical Economics Analyst

This position will play a consultative role in analyzing medical and pharmacy data from Fluent Healths clients/partners to:

1.) develop interpret and communicate medical and pharmacy cost trends

2.) identify opportunities in provider networking/contracting clinical and other areas and

3.) support benefit design and pricing to achieve medical cost improvement within the Commercial Medicare and Medicaid product lines.

Were determined to take care of those working in healthcare.

Presbyterian is dedicated to improving peoples lives - the lives of our patients and the lives of our coworkers. Were a locally owned and operated which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical wellness program vision dental paid time off retirement and more for FT employees.
• Benefits: PRN/PT (working less than a .45 FTE) employee benefits available for this position such as medical gym memberships and an employee wellness program.

• Bachelors degree in healthcare accounting finance or other quantitative/related fields. Masters degree is preferred.
• 4 years healthcare industry experience specifically medical economics / product performance analyzing
• Must have knowledge and working experience in most of:
• Claim Procedure Coding: CPT/HCPCS ICD DCSPCS DRG
• Claim Provider Coding: Bill Type POS Provider Types
• Benchmarking
• Risk Share Arrangements: Capitation Shared Risk/Savings/Penalty Quality Bonuses
• Provider/Vendor Contracting Analysis
• Claim Pricing & Provider Reimbursement
• Program/Project Pricing & Savings Valuation
• IBNR
• Forecasting/Projection/Budget
• Pricing (eg. Commercial small group/large group/individual)
• Benefit Change Determination/Pricing
• Rate Filings: Exhibits Templates Support
• Risk Adjustment/Risk Models (HCC HIX Commercial Products)
• Effective writing and oral communication skills.
• Advanced skills in MS Excel Access PowerPoint Oracle SQL and Business Objects.
• Two or more SOA exams passed is preferred.
• Tableau SAS Enterprise Guide and VBA programming knowledge and experience is preferred.

• Work closely with Finance Actuarial Underwriting clinical operations provider network and provider contracting teams.
• Utilize Millimans HCG Grouper model to perform drill-down analysis and research to identify the key drivers of medical and pharmacy cost trends.
• Consult with provider network/contracting clinical operations and others on opportunities to improve utilization initiatives and mitigate trends.
• Monthly IBNR development.
• Support on Medicare Advantage D-SNP pricing and monitor D-SNP performance monthly.
• Track document and communicate analysis and research with Med Econ teams of clients/partners.
• Provide support in development of reports as needed.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical dental vision short-term and long-term disability group term life insurance and other optional voluntary benefits.

Wellness
Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges webinar preventive screening and more.

Why work at Presbyterian
As an organization we are committed to improving the health of our communities. From hosting growers markets to partnering with local communities Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to ensure the patients members and communities we serve can achieve their best health. We are a locally owned not-for-profit healthcare system of nine hospitals a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 14000 employees.

Our health plan serves more than 580000 members statewide and offers Medicare Advantage Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.