GENERAL SUMMARY: As a Senior Medical Economics Analyst, your primary objective will be to identify, analyze, and explain emerging medical trends. You will play a crucial role in identifying opportunities for cost containment and quality improvements initiatives. PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Conduct analysis associated with medical cost containment initiatives. Analyze medical and pharmacy claims to identify early signs of trends or other issues related to medical care costs.
- Perform qualitative analysis to pinpoint cost drivers (such as utilization, pricing, and service mix), address business challenges, and continuously enhance data-driven strategies and processes to improve financial results.
- Evaluate vendor and partnership performance, focusing on value and return on investment (ROI), and communicate findings to key leadership and stakeholders.
- Collaborate with finance and business leaders to establish benchmarks for monitoring medical cost trends and variances.
- Demonstrate proficiency in healthcare/medical economics data and an understanding of healthcare industry coding systems such as ICD-10, CPT/HCPCS, and DRGs.
- Take proactive initiative and show curiosity in exploring new opportunities to enhance cost-saving strategies and improve overall financial performance.
- Participate in and/or lead cross-functional corporate business teams and meetings to develop medical economics programs.
- Communicate and present findings to key leadership and stakeholders, addressing business questions and objectives.
- Prepare reports and presentations for quarterly business meetings.
- Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Must have an undergraduate (BS) degree in Statistics, Mathematics, Economics, Public Health, and Finance or another related field.
- Master's degree preferred.
- Minimum of three (3) years of progressive analytical experience in a healthcare or managed care/insurance related setting.
- Minimum of one (1) year of experience in leading staff in projects or supervisory/management position preferred.
- Skills required: SQL, Excel.
- Skills preferred: Microsoft PowerBI, SAS, R.
- Demonstrated experience with data interpretation, analysis, and reporting; clinical and financial data; risk modeling and forecasting; key performance indicators as it relates to medical cost data.
- Demonstrated project management experience in running corporate wide projects.
- Experience in mining and migrating medical cost performance data to a single platform preferred.
The nature of the work requires progressive interpersonal communication, decision- making, financial and technical skills. Ability to ideate, improve processes, calculate measures, and leverage BI solutions to improve healthcare performance.
- Must exhibit the ability to function in an autonomous manner in a rapidly changing environment.
- High energy: strong leadership, analytical, project planning and coordination skills to enable efficient, timely task completion of deliverables that meet or exceed customer expectations.
- Demonstrated ability to function in a creative, "out-of-the-box" way of thinking to develop original solutions to overcome roadblocks and meet or exceed customer requirements and expectations.
- Knowledge of medical claims data and managed care membership data.
- Knowledge of business intelligence applications, data, and tools.
- Advanced Microsoft analytic skills (e.g., Access, Excel, and PowerBI).
- Knowledge of Medicare and Commercial Reimbursement methodologies a plus.
Additional Information
- Organization: HAP (Health Alliance Plan)
- Department: Data Analytics
- Shift: Day Job
- Union Code: Not Applicable
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Henry Ford Health System
Jan 07, 2025