Sr. Medical Economic Analyst

Carilion Clinic•Roanoke, VA

5d•Hybrid

About The Position

The Senior Medical Economist Analyst works closely with the Strategic Payment Relationships leadership to capture, integrate, transform, interpret and present healthcare data, in support of the best possible decision making and outcomes on a variety of strategic initiatives. They will lead payer analytics, payment modeling and reporting, in support of successful contract negotiations and payer performance monitoring. Onsite is preferred, hybrid or remote work option is available. Candidates residing in the following states can be considered for remote work: Alabama, Florida, Georgia, Arkansas, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, West Virginia, and Virginia. Leads modeling of commercial and government payment methodologies for all types of healthcare services: hospital, physician, ambulatory, home health, hospice, etc. Transforms data into analytical insights, to inform decisions for the Contracting team and Carilion executive stakeholders. Effectively communicates analysis to be consumed by department and executive leadership. Demonstrates expert knowledge of both commercial and governmental payers for modeling and analyzing contract proposals with a variety of reimbursement methodologies: case rates, DRG, fee schedules, stoploss and other contract terms. Leverages hospital (FinThrive) and physician (Experian MPV) claim modeling systems for enhanced payer contract analytics. Continuously learns and adapts to a constantly changing reimbursement environment. Completes extensive and complex financial and operational analyses, modeling of managed care contracts and proposals, analyze fee schedules, and determine contract performance and compliance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.

Requirements

Bachelor’s degree in computer science, accounting, business, data science, statistics, or related field. 4 years of relevant experience may be considered in lieu of degree.
Minimum 4 years of complex data analysis and data manipulation experience.
High proficiency with computers, operating systems, relational databases, and analytical and statistical software.
Demonstrated skills in research design, statistical analysis, and statistical process control methodology.
Strong analytical reasoning, problem-solving capability, written and verbal communication skills.
Ability to manage competing deadlines, prioritize tasks, and maintain accuracy while working with large volumes of data.
Ability to handle confidential and sensitive information with discretion; occasional travel may be required.

Responsibilities

Leads modeling of commercial and government payment methodologies for all types of healthcare services: hospital, physician, ambulatory, home health, hospice, etc.
Transforms data into analytical insights, to inform decisions for the Contracting team and Carilion executive stakeholders.
Effectively communicates analysis to be consumed by department and executive leadership.
Demonstrates expert knowledge of both commercial and governmental payers for modeling and analyzing contract proposals with a variety of reimbursement methodologies: case rates, DRG, fee schedules, stoploss and other contract terms.
Leverages hospital (FinThrive) and physician (Experian MPV) claim modeling systems for enhanced payer contract analytics.
Continuously learns and adapts to a constantly changing reimbursement environment.
Completes extensive and complex financial and operational analyses, modeling of managed care contracts and proposals, analyze fee schedules, and determine contract performance and compliance.
Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities.