Medical Economics Consultant

Amerihealth Caritas•,

8d•Remote

About The Position

The Medical Economics Consultant position reports to the Manager of Medical Economics and Business Processes within Actuarial Analytics. This position is primarily responsible for developing large reporting layers, reports, executive decks, and enhanced metrics for our Total Cost of Care (TCOC) revenue and expense review process. This is a 100% Remote position but you must live in EST or CST time zones. For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

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
One to three (1 – 3) years of experience working in Medical Informatics, Medical Economics, or related analytical positions at Managed Care Organizations, vendors, or providers
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, PMPM, and Cost per Unit
Understanding of enterprise approaches to either MS SQL Server & related RDBMS technologies or MS Azure & related cloud computing data lake solutions; Mastery of SQL
Strong knowledge of the anatomy of healthcare claims and/or encounters
Strong knowledge of Excel
Experience in SQL
Excellent communication skills

Nice To Haves

Technology competencies include Azure Databricks, MS SQL Server, MS Power BI, Excel Data Models, or equivalent technologies

Responsibilities

Meeting the business on needs for actionability from insight by helping develop High-Value Opportunities (HVOs) that are in the millions of dollars in savings/revenue added & validating ongoing initiative savings methodology & accounting
Consultants have technical backgrounds and will create tools and reports that draw on disparate datasets and follow departmental infrastructure and practices to generate a complete picture of our medical expense and revenue trends, primarily Medicaid by member cohort and claim category, through the use of industry-standard KPI
Consultants are expected to work with operational matrix partners to understand business processes in place to ensure reporting relevancy and present findings to leadership clearly and concisely