Mgr, Medical Economics

Horizon Healthcare Services•Hopewell, NJ

About The Position

This role provides support and consultation to the Health and Network Solutions (HNS) department by analyzing key business issues related to cost, utilization, and revenue across all Horizon BCBS products. The position involves designing and developing reports to monitor and identify the root causes of Medical and Provider cost trends. It requires collaboration with cross-functional teams to identify opportunities for medical cost reduction and to develop systemic solutions for efficiency by reducing manual processes.

Requirements

High School Diploma/GED required.
Minimum of 5 years of experience in developing complex financial models in order to drive analyses that will support business decisions.
Minimum of 3 years experience Advanced SAS and/or SQL experience where you have created queries, pulled large data sets and performed data manipulations/analysis.
Minimum of 5 years of experience in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.
Demonstrated experienced with leading big projects with cross-functional department at various levels.
Knowledge of Government Program, Commercial, Medicare market sectors and products.
Ability to communicate complex concepts to non-technical audience in digestible manner using data visualization.
Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
Advance knowledge with Excel: Work experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/formulas; creating, using and interpreting pivot tables, filtering and formatting.
Demonstrated aptitude for analytical thinking and the ability to report findings in an an accurate manner.
Demonstrated progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.
Strong problem solving and analytical skills.
Experience with relational database and techniques.

Nice To Haves

Bachelor degree in math, statistics, actuarial, finance, accounting, economics, business administration or a related field preferred or relevant experience in lieu of degree.

Responsibilities

Develops analytics to evaluate the performance of medical and provider cost activities across Health and Network Solutions (HNS) and consults with business leaders on observations and recommendations.
Identifies favorable and unfavorable trends, develops recommendations to improve trends, communicates recommendations to management, and analyzes the financial performance of all Horizon BCBS products, including Commercial, Medicare, and Medicaid.
In partnership with the director, directs the development and implementation of advanced analytic tools and techniques to identify cost drivers and ways to improve medical and provider cost performance.
Expands the evaluation of provider performance by evaluating and benchmarking providers across multiple cost of care categories and provides input and recommendations to contracting teams to guide contract negotiations, network strategy, and overall enterprise understanding of provider performance.
Partners with the director and collaborates with finance and actuarial teams to connect medical and provider cost activities to enterprise processes including forecasting, budgeting, and pricing.
Supports the director in maintaining effective internal controls over the processes and transactions under areas of responsibility, including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.
Identifies opportunities to reduce manual processes and interventions and develops systemic solutions to drive efficiency.
Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers staff salaries.