Senior Medical Cost Analytics Advisor

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

📋 Description

• Assist in strategic medical cost analytics by pinpointing trends, risks, and potential affordability opportunities within cost containment and payment integrity initiatives.

• Convert intricate findings into concise, executive-ready insights suitable for technical, operational, and senior leadership audiences.

• Take ownership of financial impact assessments and business cases, which include forecasts, variance analysis, and suggestions aimed at enhancing performance.

• Aid in program measurement and performance monitoring for both pre-payment and post-payment editing, coding audits, and recovery initiatives.

• Identify and quantify new opportunities by evaluating billing patterns, coding and reimbursement dynamics, as well as the factors contributing to wasteful or abusive practices.

• Collaborate with finance, operations, clinical, network, claims, product, vendor, and other enterprise teams to ensure insights are aligned with decisions and execution.

• Assist in vendor evaluation and sourcing through data-driven analyses that inform negotiations, pricing structures, and performance guarantees.

• Enhance data quality, reinforce controls, and facilitate scalable/self-service reporting and analytics through automation and AI-enabled tools.

⛳️ Requirements

• Bachelor’s degree in a quantitative discipline or equivalent experience.

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

• Exceptional analytical and technical abilities.

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

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

• Familiarity with professional and facility claim structures.

• Experience in regulated and compliance-conscious environments.

• Proven experience in modernizing analytics through automation and AI-enabled or advanced analytics techniques, such as predictive modeling, NLP, and machine learning.

• Capability to convert complex analyses into actionable business insights for senior and executive audiences.

• Strong collaborative and influencing abilities in a matrixed environment.

• Home internet through cable broadband or fiber optic service with a minimum of 10Mbps download and 5Mbps upload for remote work.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Comprehensive medical benefits.

• Vision coverage.

• Dental coverage.

• Programs focused on well-being and behavioral health.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement program.

• A minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence.

• Requirement for cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload for remote working.