Medical Economics Analyst

Complete Health • Jacksonville, FL

1d

About The Position

The Senior Medical Economics Analyst works with Medicare Advantage and DCE membership files to produce panel reports, identify new and termed members, and provide other Medicare Advantage and DCE membership reporting. The role supports operational and business teams by consolidating payer rosters, meeting data and reporting needs, tracking payer requirements and case outcomes, and analyzing data to improve processes and inform business outcomes.

Requirements

• Bachelor's degree in Business, Health Care Administration, Mathematics, Finance, Health Informatics, or a related field.
• At least 4 years of experience; healthcare-related experience is preferred.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office applications such as Excel, Word, and Access.
• Strong analytical, organizational, and problem-solving skills.
• Experience working with complex data sets across claims, laboratory, financial, clinical outcomes, and external sources.
• Knowledge of medical data structures, including ICD-10, CPT, HCPCS, and NDC.
• Knowledge of reimbursement models including DRG, APC, AWP+, cost plus, and PDGM.

Nice To Haves

• Experience writing SQL queries.
• Experience using Tableau, QlikView, or similar software.
• Healthcare-related experience.
• A master's degree in a relevant field; it may substitute for two years of experience.

Responsibilities

• Consolidate monthly patient rosters from payers and distribute standardized lists to departments including Value Based, Finance, and Market Clinical Operations.
• Develop monthly processes to identify new and termed members and consolidate demographic details across multiple data systems.
• Communicate with operational teams to meet their data and reporting needs.
• Track payer business requirements regarding cost reallocations and monitor case outcomes.
• Develop monthly processes and procedures to identify candidates for potential cost reallocations and complete accompanying forms for payer submission when applicable.
• Obtain and analyze data to continually improve processes, procedures, and execution.
• Maintain knowledge of current healthcare trends by reading relevant literature and attending related conferences or seminars.
• Apply business knowledge to analytics projects and provide value-added insights that directly impact business outcomes.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior