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Actuarial / Medical Economics Analyst

SoNE HEALTH

Actuarial / Medical Economics Analyst

Hartford, CT
Full Time
Paid
  • Responsibilities

    ESSENTIAL FUNCTIONS:

    This position is responsible for providing analysis and reporting related to quality, incentives, and cost and utilization drivers for value based risk contracts for commercial, Medicare advantage, and Medicare shared savings program. This position will demonstrate effective communication, both verbal and written, along with an expertise in data visualization and PowerPoint presentations. 

    RESPONSIBILITIES:

    • Manage a large set of data (some are raw flat file data), develop and adapt models for reporting and reconciliation. Review data, generate reports, interpret results from analysis/reports, and make actionable recommendations to non-financial/non-technical audience.
    • Provide analysis on data and reporting from various payers including projections, reconciliation, trends, and research outliers/patterns. 
    • Create monthly report packages and other performance metrics (i.e. SoNE Balanced Scorecard) to distribute to the various business operations including monthly cost analysis to identify high cost areas. 
    • Ability to complete work independently, and collaborate with internal and external team members and participate in ACO and/or related meetings, committees or functions.
    • Able to design and implement dashboard reports according to business requirements and technical specifications including generating charts and graphs that foster an understanding of actionable opportunities.
    • Excellent interpersonal communication (one-on-one and group) and customer service with ability to work both independently and as part of a team.
    • Strong analytical skills, with a proven ability to develop and document resolution of complex issues and understand and display unwarranted variation and trend analysis, examine irregularities in data.
    • Extremely organized, self-motivated individual able to handle fluctuating volumes of work, able to prioritize work to meet deadlines.
    • Automate / enhance processes using technical skills.
    • Work with mathematical concepts such as probability and statistical inference to apply concepts to actionable recommendations for ACO Clinical Case Managers/Coordinators, medical staff and leadership.
    • Utilizes benchmarking data to evaluate current processes as they are related to operations.
    • Prepares forecasts based on risk performance and identifies areas of risk performance improvement
    • Work with finance on (and/or possibly provide) analysis including but not limited to forecasting, risk performance, reserving (IBNR unpaid claim cost estimates), trending, valuation, variance and risk management from multiple data sources
    • Research and analyze historical revenue and cost data to project budget for the next fiscal year. 
    • Develop, maintain and distribute ad-hoc reports and financial models as needed.

    EXPERIENCE:

    • Minimum 6 years or more of financial or analytical experience in healthcare environment
    • ACTUARIAL, Health Cost of Care and Trend Analytics, or Provider Finance/Contracting experience required
    • Experience with data analysis as well as the interpretation and reporting of clinical, quality, and financial data
    • Knowledge of health care claims and clinical quality metrics
    • Experience with SQL
    • Advanced Microsoft Excel skills with the ability to write complex formulas, VBA experience preferred
    • Ability to design, evaluate and interpret complex data sets
    • Experience working with ACOs and/or PHOs preferred
    • Experience with CMS RAF & AMP Risk Adjustment Models
    • Excellent oral and written communication skills

    PHYSICAL AND MENTAL REQUIREMENTS:

    The Physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    • Ability to travel to provider offices within a broadly defined area.
    • Frequently is required to walk, sit, and stand.
    • Ability to transport and/or maneuver objects weighing up to 20 pounds.
    • Busy work environment subject to frequent interruptions and shifting potentially conflicting priorities.

    ADDITIONAL REQUIREMENTS: As a condition of employment at SoNE HEALTH and for the safety and well being of our employees, all employees are required to be fully vaccinated for influenza and COVID-19.

    SALARY: $67,290 - $87,476