Positioned within the Medical Economics department, the Medical Cost team values, implements, and tracks initiatives aimed at producing savings and bending cost trends. The team is empowered with the resources it needs to produce results and deliver impactful business recommendations. As a Senior Medical Economics Analyst, you’ll map out and construct detailed analyses, confront challenging and unfamiliar subjects, and interface with stakeholders across all departments and lines of business. The conclusions you reach have the potential to improve and influence the organization, playing an essential part in our mission to provide members with affordable and accessible high quality care. Each day you’ll tackle new and unique questions, learning and growing as you develop strategies, find solutions, and build innovative new approaches that support our goals and drive success.
The role involves managing projects from analysis to implementation and beyond, ensuring that results are achieved and leadership is aware of the unique headwinds and tailwinds faced by any initiative. The ability to simplify complex scenarios into key takeaways is essential, as is the ability to explain and drill into any given detail behind the analyses you create. You’ll be expected to make independent decisions and support them under scrutiny. Potential areas of analysis include payment policy, utilization management, and value-based payment arrangements. The ideal candidate will be eager to learn, excited to grow, ready for a challenge, and able to thrive in a collaborative and collegial work environment.
Job Description & Duties:
- Value new medical cost initiatives, applying financial modeling expertise and using independent judgement to determine the best methods and approaches to calculate accurate estimates of program savings.
- Provide data driven analysis to Finance, Claims, Medical Management, Network and other departments to enable critical decision making.
- Coordinate program implementation with initiative owners and establish controls to validate that changes have occurred.
- Thoroughly vet and perform due diligence on potential value based arrangements to assess financial impact, ensure operational feasibility, and identify impact on existing programs.
- Identify favorable and unfavorable performance trends within medical cost initiatives, communicate trends to leadership, and recommend changes to initiative owners to improve performance.
- Perform complex return on investment analyses for vendors to determine if their financial and clinical performance is achieving desired results.
- Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance.
- Bachelor’s degree from an accredited institution.
- Analytical work experience within the healthcare industry (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
- Work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis.
- Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/ formulas; creating, using and interpreting pivot tables, filtering and formatting.
- Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
- Basic understanding of Medicaid and Medicare programs or other healthcare plans.
- Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
- Strong project management experience and ability to handle multiple projects in a fast paced environment.
- Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
- Understanding of value based risk arrangements.
- Experience using Tableau.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
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