Medical Economics Consultant Senior

Amerihealth Caritas•,

5d•Remote

About The Position

The Medical Economics Consultant Senior reports to the Manager of Medical Economics & Business Process. This position is primarily responsible for leading the development of market trend analytics, enterprise-wide trends, executive decks, & enhanced metrics for our Total Cost of Care (TCOC) revenue & expense review process.

Requirements

Bachelor’s Degree in Actuarial Science, Economics, Computer Science, IT, IS, or a related field strongly preferred OR equivalent combination of education and work experience will be considered
At least five to ten (5 – 10) years of related experience with at least three (3) years working in Medical Informatics, Medical Economics, or related analytical positions at Managed Care Organizations, vendors, or providers
Technology competencies include Azure Databricks, Python, MS SQL Server, Tableau, MS Power BI, Excel Data Models or equivalent technologies.
Strong knowledge of Medicaid business and familiarity with healthcare domains (claims, UM, etc.)
Strong knowledge of health informatics terminology & classification schemes (i.e., CPT codes, ICD-10 dx, common groupers like DRGs, CCS, etc.)
Strong knowledge of industry-standard population health & quality KPIs (i.e., utilization per thousand, readmission rates, HEDIS metrics, etc.)
Strong experience in SQL, Excel and Power BI

Nice To Haves

Strong technical background & analytical insights
Strong business knowledge and the ability to work cross-functionally

Responsibilities

Effectively communicate with leadership on market trends and areas of opportunity
Responsible for recurrent review of a given market/LOBs experience to generate a complete picture of medical/pharmacy expense and revenue trends
Meet and coordinate with other business teams on actionability from insights by helping develop High-Value Opportunities (HVOs) that provide savings/revenue added
Review and validate savings methodologies and estimates for ongoing initiatives