Sr Analyst, Medical Economics (hybrid)

Complete Health • Jacksonville, FL

2d • Hybrid

About The Position

The Senior Medical Economics Analyst will be responsible for working with Medicare Advantage and DCE membership files to produce panel reports, identify new and termed members, and other Medicare Advantage/DCE membership reporting. This role involves consolidating monthly patient rosters, developing processes to identify member changes, communicating with operational teams to meet data and reporting needs, tracking business requirements related to cost reallocations, and analyzing data to improve processes. The analyst will also be expected to stay current with healthcare trends and apply business knowledge to analytics projects to impact business outcomes.

Requirements

• Excellent written and verbal communication skills and ability.
• Proficient in Microsoft Office such as Excel, Word, Access, etc.
• Strong analytical, organizational, and problem-solving skills.
• Experience working with complex data sets across claims, lab, financial, clinical outcomes, and external sources.
• Knowledge of medical data structures including, but not limited to (ICD10, CPT, HCPCS, NDC).
• Knowledge of different reimbursement models (DRG, APC, AWP+, Cost plus, PDGM).
• Bachelor's degree in Business, Health Care Administration, Mathematics, Finance, Health Informatics, or related field.
• Requires 4+ years of experience; healthcare-related experience preferred.

Nice To Haves

• Experience in writing SQL queries preferred.
• Experience with using Tableau, Qlikview, or similar software preferred.
• Masters in relevant field preferred and can be substituted for 2 years' experience.

Responsibilities

• Consolidates monthly patient rosters from payers and disseminates standardized lists to various departments.
• Develops monthly processes to identify new and termed members and consolidates demographic details across multiple data systems.
• Communicates with operational teams to meet their data and reporting needs.
• Tracks business requirements from payers regarding cost reallocations and monitors case outcomes.
• Develops monthly processes and procedures for identifying candidates for potential cost reallocations and completes accompanying forms for payer submission.
• Obtains and analyzes data to continually improve processes, procedures, and execution.
• Maintains knowledge of current healthcare trends by reading appropriate literature and attending related conferences and/or seminars.
• Applies business knowledge to analytics projects and provides value-added insights to directly impact business outcomes.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior