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Senior Medical Economics Analyst - Worcester

Company: Fallon Community Health Plan
Location: Worcester
Posted on: February 14, 2019

Job Description:

Responsibilities: Analysis, Decision Support and Business Intelligence - 45%Provide actionable analyses and reports that help monitor performance and drive decision making to reduce total medical expense and utilizationAssist in designing initiatives to impact cost drivers, including measurement and monitoring of initiatives. Identify the cost drivers, quantify variances, formulate and propose strategies and communicate the outcomes to customer, business owners and senior managementEvaluate the impact of current vs. proposed financial arrangements with providers; compare payment terms against Medicare and Medicaid reimbursement methodologiesPerform cost and utilization trend analyses at the provider, PHO, employer or other group variation. Measure actual performance against benchmarks or targetsProvide advanced analytical and reporting support to customers on various projectsLeads or assists in process improvement and special projectsRegulatory & Clinical Model Design and Support - 30%Provide support for regulatory reporting; analyze specifications to develop accurate responses or summaries for timely submissions Provide analytical support for clinical initiatives including development, evaluation and ROI analyses Evaluate the effectiveness of clinical initiatives in improving patient outcomes and reducing health care costsAd-Hoc Support - 25%Provide support for ad-hoc (i.e. one time) requests that require clinical, financial, regulatory, pharmacy and operational analysis and reporting. Prepare reports and supporting analysis for internal and external customers focused on reducing costs and utilization and enhancing healthcare system efficiency. Act as a resource for other members of the department on business issues.As a subject matter expert, train and guide other associates in the department in data understanding and analytical processes. Qualifications: EducationBachelor's degree in Business, Finance or Public Health ExperienceMinimum of 5 years of financial or analytical experience in healthcare environmentExperience with data analysis, interpretation and reporting of clinical and financial data Experience with Microsoft Excel, ACCESS, SSMS or SQLAbility to design, evaluate and interpret complex data setsKnowledge of managed care and health care claims Excellent oral and written communication skills JT18 3

Keywords: Fallon Community Health Plan, Worcester , Senior Medical Economics Analyst - Worcester, Accounting, Auditing , Worcester, Massachusetts

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