Senior Analyst, Medical Economics

CVS Health•Work At Home-Texas, TX

2d•$46,988 - $102,000

About The Position

Performs complex medical economics projects, including contract rate modeling, and identifies and completes key deliverables to meet business objectives. Develops and implements medical economics business efforts such as medical cost initiatives, policies and programs, budgets, and analytical models. Partners with Network Management to analyze medical costs and assess contracted-rate effectiveness, then develops and implements plans to manage medical costs based on analysis and trends. Develops market-specific provider reimbursement schedules, oversees standard and ad hoc reporting for risk assessment, budgeting, hospital chargemaster analysis, and forecasting, and coordinates rate approvals and pricing for complex contractual arrangements. Develops and communicates tactical and strategic plans to meet information needs across products, segments, and markets.

Requirements

At least 3 years of demonstrated leadership and/or project management experience.
At least 3 years of healthcare and/or analysis experience.
Bachelor's degree or equivalent work experience required.

Nice To Haves

Knowledge of managed care and how provider reimbursement policies relate to controlling medical claims costs.
Comprehension of provider contracts and the potential impact of the regulatory and legislative environment on reimbursement strategies.
Understanding of internal and external database applications.
Knowledge of marketplace delivery and provider relationships.
Strong communication and presentation skills.
Strong software and modeling skills.
Strong analytical ability and familiarity with advanced financial and healthcare concepts.
Ability to manage conflicting priorities and multiple projects concurrently.

Responsibilities

Perform complex medical economics projects, including contract rate modeling.
Identify and complete key deliverables to ensure business objectives are met.
Develop and implement medical economics efforts, including medical cost initiatives, policies and programs, budgets, and analytical models.
Partner and consult with Network Management to analyze medical costs and assess the effectiveness of contracted rates.
Develop and implement plans to manage medical costs based on analysis and trends.
Develop market-specific provider reimbursement schedules.
Oversee standard and ad hoc reports for risk assessment analysis, budgeting, hospital chargemaster analysis, and forecasting.
Coordinate rate approvals and develop pricing for complex contractual arrangements.
Develop and communicate tactical and strategic plans that satisfy information needs across products, segments, and markets.