Medical Economics Analyst
We have a current opportunity for a Medical Economcis Analyst - Replace on a permanent basis. The position will be based in Jacksonville, FL and they are looking for someone to work hybid.
Key Responsibilities:
- Analyze and interpret complex medical data related to Medicare Advantage and value-based care programs, focusing on cost, utilization, and outcomes.
- Use advanced SQL to extract, manipulate, and analyze large datasets to identify trends, anomalies, and opportunities for improvement.
- Develop financial models to assess the performance of Medicare Advantage plans and value-based care initiatives.
- Provide recommendations to improve care quality, reduce costs, and optimize performance within value-based care arrangements.
- Collaborate with cross-functional teams (actuaries, clinicians, and leadership) to align data analysis with strategic business goals.
- Evaluate and support the implementation of risk adjustment models and ensure the accurate application of HCC coding for Medicare Advantage plans.
- Prepare detailed reports and presentations for senior management, focusing on key performance indicators, cost trends, and opportunities for growth.
- Monitor and analyze industry trends, regulatory changes, and performance metrics in value-based care to inform internal strategy.
- Ensure compliance with Medicare Advantage regulations and CMS guidelines related to reporting, claims, and financial analysis.
Qualifications:
- Bachelor's degree in Healthcare Economics, Public Health, Business Administration, Data Analytics, or a related field.
- 3+ years of experience in medical economics or healthcare analytics, with specific expertise in Medicare Advantage and value-based care.
- Strong proficiency in SQL for data extraction, manipulation, and analysis.
- In-depth knowledge of Medicare Advantage plan structures, regulations, and reimbursement models.
- Experience with value-based care models (e.g., ACOs, bundled payments) and understanding of risk-sharing arrangements.
- Familiarity with risk adjustment, including HCC coding and CMS guidelines.
- Strong analytical skills with the ability to analyze large datasets and identify key trends, insights, and cost-saving opportunities.
- Experience with data visualization tools such as Tableau or Power BI is a plus.
- Strong written and verbal communication skills, with the ability to present complex data to both technical and non-technical stakeholders.
- Ability to work independently, manage multiple priorities, and meet deadlines in a fast-paced environment.
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