Medical Economics Analyst

Presbyterian Healthcare Services

7d • $77,563 - $118,394 • Remote

About The Position

Build your Career. Make a Difference. Presbyterian is hiring a skilled Medical Economics Analyst to join our team. Presbyterian is seeking a Medical Economics Analyst This position will play a consultative role in analyzing medical data, specializing in reporting savings for payment integrity related processes, including pre-payment claim edits, pricing adjustments, and other cost-reduction initiatives. Reconciliation to vendor invoicing to ensure appropriate fee payments will also be integral to the role, along with creating and modifying SAS-based solutions for these processes. Will be required to perform financial impact quantifications and projections that will impact budget setting. Expected to investigate, suggest, and develop different modelling avenues and varying data sets. Will own quantification process including reporting various perspectives of impact within in integrated delivery system.

Requirements

• Bachelors degree in healthcare, accounting, finance or other quantitative/related fields.
• Four years healthcare industry experience, specifically medical economics / product performance analyzing Claim Procedure Coding: CPT/HCPCS, ICD DCS+PCS, DRG Claim Provider Coding: Bill Type, POS, Provider Types Benchmarking Risk Share Arrangements: Capitation, Shared Risk/Savings/Penalty, Quality Bonuses Provider/Vendor Contracting Analysis Claim Pricing & Provider Reimbursement Program/Project Pricing & Savings Valuation IBNR Forecasting/Projection/Budget Pricing (eg., Commercial small group/large group/individual) Benefit Change Determination/Pricing Rate Filings: Exhibits, Templates, Support Risk Adjustment/Risk Models (HCC, HIX, Commercial Products)
• Effective writing and oral communication skills.
• Advanced skills in MS Excel, Access, PowerPoint, Oracle SQL, and Business Objects.

Nice To Haves

• Masters degree is preferred.
• Two or more SOA exams passed is preferred.
• Tableau, SAS Enterprise Guide, and VBA programming knowledge and experience is preferred.

Responsibilities

• Work closely with Finance, Actuarial, Underwriting, clinical operations, provider network and provider contracting teams.
• Utilize Millimans HCG Grouper model to perform drill-down analysis and research to identify the key drivers of medical and pharmacy cost trends.
• Consult with provider network/contracting, clinical operations and others on opportunities to improve utilization initiatives and mitigate trends.
• Monthly IBNR development.
• Support on Medicare Advantage D-SNP pricing and monitor D-SNP performance monthly.
• Track, document and communicate analysis and research with Med Econ teams of clients/partners.
• Provide support in development of reports as needed.

Benefits

• All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
• Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

What This Job Offers

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