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 membership reporting. The role consolidates monthly patient rosters from payers and distributes standardized lists to departments such as Value Based, Finance, and Market Clinical Operations. It develops processes to identify new and termed members and consolidates demographic details across multiple data systems.

The analyst communicates with operational teams about their data and reporting needs, tracks payer requirements regarding cost reallocations, and monitors case outcomes. The role develops procedures for identifying candidates for potential cost reallocations and completes related forms for payer submission when applicable. It also obtains and analyzes data to improve processes and execution, stays informed about healthcare trends through literature and conferences or seminars, and applies business knowledge to analytics projects to provide insights that affect 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.
• Strong 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 2 years of experience.

Responsibilities

• Consolidate monthly patient rosters from payers and distribute standardized lists to relevant departments.
• 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 healthcare trends by reading relevant literature and attending conferences or seminars.
• Apply business knowledge to analytics projects and provide value-added insights that impact business outcomes.

What This Job Offers

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