Senior Analyst - Medical Economics (Remote)

About the Role

We are hiring a Senior Analyst - Medical Economics (Remote) to support data-driven decision making across the organization. This role is pivotal in analyzing healthcare cost and utilization trends, developing actionable insights, and supporting strategic initiatives that improve performance and patient outcomes.

What You'll Do

• Mine data to discover key analytical insights for decision support, focusing on evaluating and improving financial and operational performance on our health plan, institutional, and provider contracts.
• Build deal models for health plan, institutional, and provider contract negotiations, including Medicare Advantage, Commercial Risk, Medi-Cal, and Fee-for-Service.
• Identify cost-of-care savings opportunities by analyzing physician authorizing/billing patterns in relation to hospital admissions, emergency room visits, office visits, referral practices, and specialty care procedures, providing suggestions for vendor contract changes that can result in cost savings.
• Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis, and propose corrective action plans.
• Perform pro forma sensitivity analyses to estimate the expected financial value of proposed medical cost improvement initiatives.
• Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs.
• Evaluate the financial impact of quality incentive contracts based on quality measure datasets (AWV, HEDIS, and HCC).
• Use data tools (e.g., SQL, Excel) for tracking, analyzing, forecasting, and reporting on payors and hospitals’ financial impact.
• Identify, develop, and document audit findings to present to key stakeholders.
• Help develop proprietary analytics infrastructure, including various reports and dashboards, supporting our institutional and payor financial performance.
• Complete a variety of strategic ad-hoc projects on large data sets.

Requirements

• Bachelor's degree in a quantitative field such as finance, statistics, economics, math, or engineering is preferred; Master’s degree (MBA, MHA, MPH, healthcare economics related) is preferred.
• 2+ years of full-time experience in managed care or healthcare data analytics; Health Plan or Provider Group experience preferred.
• Prior experience in an analytical/reporting role developing financial and operational models.
• 2+ years of working with large data sets.
• Working knowledge of healthcare pricing and reimbursement methodologies for Medicare, Medicaid/Medi-Cal.
• Demonstrated understanding of Commercial, Medicare, Medicaid programs, and healthcare policy trends (e.g., value-based care).
• Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (CPT, HCPCS, NDC, DRG, etc.) utilized in medical coding/billing.
• Advanced Microsoft Excel skills (e.g., pivot tables, data manipulation, power query), PowerPoint, and Word required.
• Advanced proficiency in SQL is required.
• Experience working with business intelligence tools such as Tableau or Power BI.

What We Offer

• Competitive salary range of $100,000 - $120,000 based on experience and location.
• Fully remote work environment, allowing flexibility and work-life balance.
• Opportunities for professional development and growth within the organization.
• Comprehensive benefits package including health insurance, retirement plans, and paid time off.
• Collaborative and innovative work culture focused on improving healthcare outcomes.