Job Summary:
The Medical Economics Analyst III is responsible for being proficient in identifying, quantifying and modeling opportunities to reduce medical costs within the market and presenting summarized analytical findings and recommendations to management.
Essential Functions:
- Identify and quantify cost savings initiatives to reduce medical costs within the markets
- Build financial models to quantify impact of medical cost reduction initiatives
- Assess overall health plan performance by analyzing medical cost, utilization trends, risk adjustment dynamics, revenue impacts, and identifying key drivers, outliers, and opportunities for optimization
- Combine strong technical skills in SQL and Excel/Power BI with critical thinking, business acumen, and the ability to refine and edit analyses for accuracy and clarity
- Extract, manipulate, and validate large healthcare claims datasets using SQL and Microsoft Excel/Power BI
- Develop tools to efficiently identify new opportunities for cost savings
- Partner with various departments within organization to discuss, develop and solution medical cost reduction initiatives
- Evaluate the effectiveness of medical cost reduction initiatives
- Present analytical findings and recommendations
- Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
- Perform any other job duties as requested
Education and Experience:
- Bachelor’s Degree or equivalent years of relevant work experience is required
- Advanced degree is preferred
- Minimum of five (5) years of experience in healthcare analytics is required
- Managed care experience is required
Competencies, Knowledge and Skills:
- Advanced knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data and demographic data
- Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is required
- Advanced Excel proficiency (pivot tables, lookups, financial modeling, data validation)
- Advanced SQL skills (data extraction, joins, aggregations, subqueries)
- Ability to organize data in a way which facilitates inferences, conclusions and decisions
- Strong analytical, problem solving and critical thinking skills
- Ability to balance competing priorities
- Demonstrated written and verbal communication skills
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$83,000.00 - $132,800.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
Originally posted on Himalayas