The Senior Medical Economics Analyst is a key member of the Finance management team whose responsibility is to function as a strategic partner with various functional areas throughout the organization to meet corporate objectives. This includes the development and analytics related to utilization management tools, alternative provider payment models, and actuarial pricing and reserving.

KEY FUNCTIONS/RESPONSIBILITIES:

• Uses SAS and/or SQL coding to extract and manipulate claims, membership and other healthcare data to support advanced healthcare analytics.
• Directs the design, development and implementation of evaluation tools in measuring the effectiveness of both internally developed medical management initiatives or externally purchased vendor programs.
• Supports the development and evolution of BMCHP’s alternative payment model strategy.
• Models financial impact of alternative provider payment proposals, including the valuation of counter-proposals.
• Develops and implements plans to measure and report on corporate-wide health care delivery cost and utilization trends; collaborates with subject matter experts’ (SMEs) in developing sound methodology for forecasting trends (participates in corporate trend team).
• Leads the development and ongoing maintenance of annual CHIA submissions as well as other regulatory and contractually required submissions.
• Produces data to support Monthly Reserve Analysis, assists in creation and validation of Medical Budget, and supports provider efficiency analytics.
• Measures, monitors, and communicates provider settlements related to alternative payment models as well as other payment arrangements. Responsible for advanced adhoc analytics including modeling of contract and benefit scenarios and data to support provider negotiations and contract renewals. Presents and communicates key financial terms to Provider contracting team and external provider constituencies.
• Develops and maintains plan-wide and department specific dashboards, and applies risk adjustment methodologies in analysis.
• Serves as data expert for department. Advises Finance department on data warehouse redesign requests and works with IT to establish priorities.

QUALIFICATIONS:

 EDUCATION:

• Bachelor’s Degree in Finance, Health Care Administration, or related field required. 
• Master’s Degree in a related field preferred.

EXPERIENCE:

• Four or more years progressively responsible experience in managed care data analysis and reporting is required.  
• Three or more years conducting advanced analytics using SAS and/or SQL.   
• A background in managed healthcare, insurance operations required.

COMPETENCIES, SKILLS, AND ATTRIBUTES_:  _

• Working knowledge of MS tools, including MS Office products, MS Access, MS Project, Visual Basic, Crystal Reports, and data modeling tools such as Erwin.
• Ability to integrate external grouping methodologies such as DRG, ETG and DxCG in analytics. 
• Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
• Strong communications skills, both verbal and written, are required.

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

Required Skills Required Experience