Mgr, Medical Economics

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

About The Position

This role provides support and consultation to the Health and Network Solutions (HNS) by analyzing key business issues related to cost, utilization, and revenue for all Horizon BCBS products. The Manager will design and develop reports to monitor and identify the root causes of Medical and Provider cost trends, collaborate with cross-functional teams to identify opportunities to reduce medical costs, and identify opportunities to reduce manual processes and develop systemic solutions for efficiency.

Requirements

High School Diploma/GED required.
Requires minimum of 5 years of experience in developing complex financial models in order to drive analyses that will support business decisions.
Requires 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.
Requires a 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.
Requires demonstrated experienced with leading big projects with cross-functional department at various levels
Requires knowledge of Government Program, Commercial, Medicare market sectors and products.
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.
Requires a demonstrated aptitude for analytical thinking and the ability to report findings in an accurate manner.
Requires a 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, and develops recommendations to improve trends, communicate 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 evaluating and benchmarking providers across multiple cost of care categories and provide input and recommendations to contracting teams in order 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 the 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 develop systemic solutions to drive efficiency.
Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers staff salaries.