Senior Medical Cost Analytics Advisor

This is a fully remote position, open to applicants in United States.

📋 Description

• Deliver strategic and analytical assistance to the Payment Integrity team.

• Assess both pre-payment and post-payment editing, clinical coding audits, and recovery initiatives.

• Convert payment integrity program performance and outcomes into actionable insights and business cases.

• Recognize and quantify new savings opportunities.

• Detect trends, risks, and affordability possibilities within cost containment and payment integrity initiatives.

• Transform complex findings into executive-ready insights and aid the strategic roadmap.

• Manage financial impact assessments and business cases, including forecasts, variance analyses, and performance recommendations.

• Facilitate program measurement and performance tracking through dashboards, scorecards, and executive materials.

• Analyze billing patterns, coding and reimbursement dynamics, and factors contributing to wasteful or abusive practices.

• Collaborate across finance, operations, clinical, network, claims, product, vendor, contracting, coverage policy, compliance, reserving, and analytics teams.

• Assist in vendor assessment and sourcing by analyzing negotiations, pricing structures, and performance guarantees.

• Enhance data quality, reinforce controls, and enable scalable self-service analytics through automation and AI-driven tools.

⛳️ Requirements

• Bachelor’s degree in a quantitative discipline such as Economics, Finance, Data Science, Data Analytics, Actuarial Science, Business, Public Health, or Applied Mathematics, or equivalent experience.

• Over 8 years of progressive experience in medical cost analytics, payment integrity, financial modeling, or related areas.

• Exceptional analytical and technical capabilities.

• Practical experience with SQL, Excel, SAS, Tableau, Databricks, or comparable platforms.

• Understanding of reimbursement methodologies and coding, including MS-DRG, APCs, HCPCs, and RBRVS.

• Familiarity with both professional and facility claim structures.

• Experience in regulated and compliance-focused environments.

• Background in modernizing analytics through automation and advanced analytics techniques, such as predictive modeling, NLP, and machine learning.

• Capacity to translate complex analyses into actionable business insights for senior and executive audiences.

• Strong collaboration and influencing abilities in a matrixed setting.

• Self-starter attitude towards continuous improvement, ownership, and impact.

• For occasional or permanent remote work, a cable broadband or fiber optic internet connection with a minimum of 10 Mbps download and 5 Mbps upload speed is required.

🏝️ Benefits

• Eligibility for annual bonus plan

• Medical insurance

• Vision insurance

• Dental insurance

• Well-being and behavioral health programs

• 401(k) plan

• Company-funded life insurance

• Tuition reimbursement

• At least 18 days of paid time off annually

• Paid holidays

• Leaves of absence