Sr Medical Economics Analyst

Adventist Health • Maitland, FL

132d

About The Position

A Senior Medical Economics analyst is responsible for analyzing and evaluating financial and economic data related to healthcare costs and managed care payer rates and reimbursement. The role focuses on financial trends, reimbursement methodology, data tools, modeling, and managing revenue. Must be able to complete extensive and complex financial and operational analyses of managed care contracts and proposals, analyze fee schedules, and determine contract compliance. The Senior Medical Economics analyst must have attention to detail and competencies in decision support and reporting through converting raw data into meaningful applications to support executive decision making. Character traits to include: Strong work ethic, trainability, communicative, team player, and strong analytical skills. The Senior Medical Economics Analyst will work with managed care staff for both in the Florida and Multi-State Divisions of AdventHealth, as well as represent AdventHealth managed care to payers in all AdventHealth Markets.

Requirements

• Bachelor's degree.
• Working knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation.
• Working knowledge of population health, utilization measurement, and claims analytics.
• Experience in Managed Care, Patient Financial services, health insurance claims processing, contract management, or medical economics.
• Proficiency in understanding professional and facility claims and managed care concepts such as risk adjustment, capitation, FFS, DRG, APG, APCs and other payment mechanisms.
• Experience in modeling financial impact of changes.
• Strong ability to handle multiple projects including problem solving, research, analysis, and communication in a fast-paced environment.
• Intermediate level of proficiency working with MS Excel including Formulas, calculations, charts, and graphs.
• Strong skills in analytical/problem solving and presentations.

Nice To Haves

• Master's degree.
• 4+ years of work experience.
• EPIC-Hospital Billing Certification (EPIC HB).

Responsibilities

• Researches and analyzes managed care data from various financial systems and interface tools.
• Performs complex and varied healthcare data analysis, including financial modeling and risk forecasting.
• Identifies and implements improvements in quality control and timeliness of reporting.
• Extracts, collects, analyzes, and interprets health utilization and financial data.
• Interprets and analyzes data from various sources using knowledge of healthcare managed care contracts and administrative claims data.
• Employs existing complex models and implements them on new projects and contexts.
• Designs new solutions for data and analytic challenges faced by the organization.
• Supports negotiations of capitated and other value-based agreements through detailed data analytics.
• Develops financial models to inform negotiation parameters.
• Evaluates possible changes to key terms in existing value-based agreements.
• Identifies risk and exposure associated with various reimbursement structures.
• Produces prospective analyses on new ventures, products, and service offerings.
• Prepares and presents analytics or project results to key stakeholders for review and decision-making.
• Evaluates and understands contract language related to reimbursement methodologies for various provider types.
• Applies detailed understanding of medical coding.
• Other duties as assigned.

Benefits

• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 501-1,000 employees