Medical Economics Analyst III
About The Position
The Medical Economics Analyst III is responsible for being proficient in identifying, quantifying and modeling opportunities to reduce medical costs within the market and presenting summarized analytical findings and recommendations to management. Essential Functions: Identify and quantify cost savings initiatives to reduce medical costs within the markets Build financial models to quantify impact of medical cost reduction initiatives Assess overall health plan performance by analyzing medical cost, utilization trends, risk adjustment dynamics, revenue impacts, and identifying key drivers, outliers, and opportunities for optimization Combine strong technical skills in SQL and Excel/Power BI with critical thinking, business acumen, and the ability to refine and edit analyses for accuracy and clarity Extract, manipulate, and validate large healthcare claims datasets using SQL and Microsoft Excel/Power BI Develop tools to efficiently identify new opportunities for cost savings Partner with various departments within organization to discuss, develop and solution medical cost reduction initiatives Evaluate the effectiveness of medical cost reduction initiatives Present analytical findings and recommendations Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization Perform any other job duties as requested
Requirements
- Bachelor’s Degree or equivalent years of relevant work experience is required
- Minimum of five (5) years of experience in healthcare analytics is required
- Managed care experience is required
- Advanced knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data and demographic data
- Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is required
- Advanced Excel proficiency (pivot tables, lookups, financial modeling, data validation)
- Advanced SQL skills (data extraction, joins, aggregations, subqueries)
- Ability to organize data in a way which facilitates inferences, conclusions and decisions
- Strong analytical, problem solving and critical thinking skills
- Ability to balance competing priorities
- Demonstrated written and verbal communication skills
Nice To Haves
- Advanced degree is preferred
Responsibilities
- Identify and quantify cost savings initiatives to reduce medical costs within the markets
- Build financial models to quantify impact of medical cost reduction initiatives
- Assess overall health plan performance by analyzing medical cost, utilization trends, risk adjustment dynamics, revenue impacts, and identifying key drivers, outliers, and opportunities for optimization
- Combine strong technical skills in SQL and Excel/Power BI with critical thinking, business acumen, and the ability to refine and edit analyses for accuracy and clarity
- Extract, manipulate, and validate large healthcare claims datasets using SQL and Microsoft Excel/Power BI
- Develop tools to efficiently identify new opportunities for cost savings
- Partner with various departments within organization to discuss, develop and solution medical cost reduction initiatives
- Evaluate the effectiveness of medical cost reduction initiatives
- Present analytical findings and recommendations
- Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
- Perform any other job duties as requested
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
