Senior Medical Economics Analyst
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POST DATE 9/15/2016
END DATE 10/16/2016
JOB DESCRIPTIONJOB SUMMARY: The Senior Medical Economics Analyst is responsible for collecting, analyzing and interpreting health care data including claims, capitation, member, and provider information. This position completes analyses with actionable conclusions required to proactively support medical management activities, provider contracting and management activities, financial and accounting activities, and other senior leaders of the company. The Medical Economics Analyst provides key information critical to decision making, leveraging advanced spreadsheet, development, and database skills to deliver value to key stakeholders
Job Responsibility: Serves as the point of authority in the analysis of complex health care issues, including analysis of both health care utilization and unit cost metrics, complex financial analysis and development of advanced analytic outputs. Develops analytic narratives that include executive summaries, significant findings, conclusions and recommendation for actions.
*Design and develop reports and analyze data to measure clinical outcomes, network performance and methodology levers
*Develops medical cost reporting, including standardization of cost categories of service, unit cost and utilization metrics
*Assists in development of business requirements for decision support tools and reports
*Create dashboards generated from trend data, utilization authorization, risk adjustment, and claims data to support departmental functions
*Models hospital, physician and ancillary contracts in order to advise network contractors during rate negotiations, as well as provide monthly analysis of overall network performance.
Manages deliverables and documentation:
*Receive, interpret and complete data requests from Finance and other departments
*Lead requirement analysis, validation and verification, ensuring that requirement statements are complete, consistent, concise, comprehensible, traceable, feasible, unambiguous, and verifiable actionable.
*Interprets business request, efficiently gathers data, and consistently formulates actionable conclusions.
*Manages requirements traceability information and track requirements status throughout the project.
*Participates in the peer review process to ensure all reports are reviewed before distribution
*Displays a high level of critical thinking to address complex business problems
*Creates actionable information and effectively communicates results that support findings to customers
*Collaborates with internal and external partners to understand data needs and design analytic studies that provide actionable results
*Supports Medical and Financial programs through monitoring and tracking of initiatives
*Proactively identifies potential areas for medical cost improvements and alternative pricing strategies
*Maintains and distributes monthly reports to members of the senior leadership team including refreshing of standard reports as well as designing and providing ad hoc reports upon requests.
*Deliverables are generated and distributed timely, reflecting detailed and accurate information
*Updates the Medical Economics department ticketing system
*Manages change to requirements through effective use of change control processes and tools
*Creates and maintains high quality documents, and adheres to quality standards set by Management.
*Assists in enforcement of project deadlines, schedules, and methodologies
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment while still being valued for your individual strengths Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled Professional Competencies (knowledge, skills, and abilities):
Data Mining, preferably within a healthcare environment
Data analysis and insights
Business and finance principles and practices
Software systems, preferably in a healthcare insurance environment
Excellent written and verbal communication
Business intelligence platforms
Excel, Access, and SQL; other language a plus
Complete tasks with little supervision
Ability to think analytically and make independent decisions
Ability to manage large workload
Ability to maintain a positive work environment
Ability to maintain positive work relationships
Handle multiple and changing priorities at a fast pace
Work cooperatively, positively, and collaboratively in an interdisciplinary team
Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames
Bachelor s degree (B.A.) or equivalent obtained at a four-year college or university preferred
Job: Business Services/Medical Records
Primary Location: Arizona-Phoenix
Organization: Health Choice
Education Level: Bachelor's Degree
Employee Status: Full Time Benefit Eligible 36-40 hrs/wk
Work Schedule: Days