Medical Economics Analyst Hybrid

Complete Health•Jacksonville, FL

3d•Hybrid

About The Position

The Medical Economics Analyst / Senior Analyst will be responsible for working with Medicare Advantage and DCE membership files to produce panel reports, identify new and termed members, and other Medicare Advantage/DCE membership reporting. This role requires proficiency in SQL Server and involves consolidating monthly patient rosters, identifying new and termed members, and consolidating demographic details. The analyst will communicate with operational teams to meet their data and reporting needs, track business requirements from payers regarding cost reallocations, and monitor case outcomes. Additionally, the role involves developing monthly processes for identifying candidates for potential cost reallocations and completing necessary forms for payer submission. The analyst will obtain and analyze data to improve processes and procedures, maintain knowledge of current healthcare trends, and apply business knowledge to analytics projects to provide value-added insights that impact business outcomes.

Requirements

Proficient in using SQL Server is a must
Excellent written and verbal communication skills and ability.
Proficient in Microsoft Office such as Excel, Word, Access, etc.
Strong analytical, organizational, and problem-solving skills.
Experience working with complex data sets across claims, lab, financial, clinical outcomes, and external sources.
Knowledge of medical data structures including, but not limited to (ICD10, CPT, HCPCS, NDC)
Knowledge of different reimbursement models (DRG, APC, AWP+, Cost plus, PDGM)
Bachelor's degree in Business, Health Care Administration, Mathematics, Finance, Health Informatics, or related field.
Proficient in SQL Server and Microsoft Suite

Nice To Haves

Experience with using Power BI strongly preferred.
Requires 1- 2+ years of experience in healthcare-related data analysis is strongly preferred.
Masters in relevant field preferred and can be substituted for 2 years' experience.

Responsibilities

Consolidates monthly patient rosters from payers and disseminates standardized list to various departments (Value Based, Finance, Market Clinical Operations, etc.).
Develops monthly process to identify new and termed members and work across multiple data systems to consolidate demographic details.
Communicates with operational teams to meet their data and reporting needs.
Tracks business requirements from payers regarding cost reallocations and monitors case outcomes.
Develops monthly processes and procedures for identifying candidates for potential cost reallocations and completes accompanying forms, if applicable, for payer submission.
Obtain and analyze data to understand how to continually improve processes, procedures and execution.
Maintain knowledge of current healthcare trends by reading appropriate literature and attending related conferences and/or seminars.
Relied upon to apply business knowledge to analytics projects and provide value-added insights to directly impact business outcomes.