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Role Description

We are hiring a Senior Analyst – Medical Economics to support data-driven decision making across the organization. Reporting to the Director of Medical Economics, this role plays a key part in analyzing healthcare cost and utilization trends, developing actionable insights, and supporting strategic initiatives that improve performance and patient outcomes.

The Senior Analyst will work cross-functionally to translate complex data into meaningful recommendations and help scale our analytics capabilities in a fast-growing healthcare environment.

• Mine data to discover key analytical insights for decision support, focusing on evaluating & improving financial and operational performance on our health plan, institutional, and provider contracts
• Build deal models for health plan, institutional, and provider contract negotiations, including Medicare Advantage, Commercial Risk, Medi-Cal, and Fee-for-Service
• Identify cost-of-care savings opportunities by analyzing physician authorizing/billing patterns in relation to hospital admissions, emergency room visits, office visits, referral practices, and specialty care procedures and provide suggestions for vendor contract changes that can result in cost savings
• Proactively identify and investigate complex suspect areas regarding medical cost issues, initiate in-depth analysis and propose a corrective action plan
• Perform pro forma sensitivity analyses to estimate the expected financial value of proposed medical cost improvement initiatives
• Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs
• Evaluate the financial impact of quality incentive contracts based on quality measure dataset (AWV, HEDIS, and HCC)
• Use data tools (e.g. SQL, Excel) for tracking, analyzing, forecasting, and reporting on payors & hospitals’ financial impact
• Identify, develop, and document audit findings to present to key stakeholders
• Help develop proprietary analytics infrastructure, including various reports and dashboards, supporting our institutional and payor financial performance
• Complete a variety of strategic adhoc projects on large data sets

Qualifications

• Bachelor's degree in quantitative field such as finance, statistics, economics, math or engineering is preferred; Master’s degree (MBA, MHA, MPH, healthcare economics related) is preferred
• 2+ years of experience full-time in managed care or healthcare data analytics field; Health Plan or Provider Group experience preferred
• Prior experience in an analytical/reporting role developing financial and operational models
• 2+ years of working with large data sets
• Working knowledge of healthcare pricing and reimbursement methodologies for Medicare, Medicaid/Medi-Cal
• Demonstrated understanding of Commercial, Medicare, Medicaid programs and healthcare policy trends (e.g. value-based care)
• Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (CPT, HCPCS, NDC, DRG, etc.) utilized in medical coding/billing
• Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing etc)
• Advanced Microsoft Excel skills (e.g. pivot tables, data manipulation, power query), PowerPoint, and Word required
• Advanced proficiency SQL is required
• Experience working with business intelligence tools such as Tableau or Power BI

Requirements

• This position is remotely based in the U.S.
• The national target pay range for this role is $100,000 - $120,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.