Senior Medical Economics Analyst

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

📋 Description

• Develop and sustain advanced risk-adjusted performance models for provider groups utilizing CMS-HCC methodology.

• Evaluate value-based care performance under CMS and CMMI total cost-of-care frameworks.

• Oversee and project financial performance for assigned patient populations.

• Conduct claims analysis utilizing CCLF and BCDA datasets, including simulating CMS-HCC risk adjustments.

• Process and evaluate extensive healthcare datasets from EHR systems, Medicare claims, and various data sources.

• Ensure the quality and integrity of data throughout analytical procedures.

• Generate analytical reports that convert intricate actuarial results into actionable business insights.

• Create executive dashboards and performance metrics that align with the organization's objectives.

• Present insights and recommendations to leadership teams and clinical stakeholders.

• Assist in budget planning and financial forecasting.

• Stay updated on CMS and CMMI program requirements and quality measures.

• Collaborate with revenue cycle and coding teams to enhance documentation and billing accuracy.

⛳️ Requirements

• Bachelor's degree in Data Science, Statistics, Mathematics, Economics, Business Administration, or a related quantitative field.

• 3-5 years of experience in data analytics, preferably within healthcare or Medicare-centric environments.

• In-depth understanding and practical experience with Medicare risk adjustment and CMS-HCC models.

• Proven experience with CMS and CMMI's total cost-of-care ACO programs.

• Demonstrated ability in analyzing Medicare claims data, particularly CCLF and BCDA datasets.

• Comprehensive knowledge of healthcare billing processes from both provider and CMS perspectives.

• Advanced skills in Microsoft Excel, including pivot tables and complex formulas; VBA knowledge is preferred.

• Strong SQL capabilities, including crafting complex queries and optimizing database performance.

• Experience with the Microsoft Azure cloud platform and relevant analytics tools.

• Proven track record of working with very large datasets and integrating data from multiple sources.

• Experience in merging EHR data with claims datasets for population health analysis.

• Exceptional analytical and problem-solving skills.

• Strong business acumen with the ability to translate technical findings into strategic recommendations.

• Excellent written and verbal communication skills suitable for both technical and non-technical audiences.

• Collaborative mindset for cross-functional projects.

• Ability to understand and adapt to changing business needs.

• Capability to handle sensitive healthcare information while maintaining strict confidentiality in line with HIPAA and applicable regulations.

• Candidates must disclose any current or future requirements for employment-based immigration sponsorship prior to an offer being extended.

🏝️ Benefits

• Medical, Dental, Vision, and additional benefits including Life Insurance, Short Term and Long Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity.

• Paid Time Off.

• Paid Office Holidays.

• Paid Sick Time.

• 401(k) plan with up to a 3% company match.

• Referral Program.

• Payactiv: pay-on-demand, allowing you to cash out earned money whenever you need it!