Medical Economics Analyst - Full Time - Days - Corporate

The Medical Economics Analyst supports the Senior Manager of Managed Care Analysts with fee‑for‑service contract modeling, contract performance evaluation, and provides overall analytical support across the Managed Care Department. Primary responsibilities include evaluating contract performance, identifying revenue cycle opportunities, and supporting population health and value‑based program analytics. The analyst develops, measures, and communicates real‑time reporting tools that support contractual and performance‑based payment models. The role applies strong financial and analytical skills to perform complex analyses that guide data‑driven decision‑making and advance key organizational goals. Additional responsibilities include general projects assigned by Managed Care leadership.


Responsibilities: 

Medical Economics Analyst responsibilities include:

• Support all aspects of contracting lifecycle as they pertain to the economic impact to AH: 

  • Analyze current and future contracts for economic opportunities or risk

  • Independently reprice facility and professional based contracts to create impact assessments

  • Forecast the feasibility and potential financial benefit or risk associated with pay-for-performance and value-based contracts

  • Develop ROI models to show value of new and existing programs.

  • Oversee the maintenance, optimization, and future transition of Spotfire or its replacement analytics platform

  • Analyze and assess existing and newly acquired entities to develop contracting analytics, reimbursement proposals, and rate positioning strategies.

  • Evaluate market dynamics, financial performance, and reimbursement opportunities to support contract negotiations and strategic rate recommendations.

  • Partner with contracting and operational leaders to identify opportunities, quantify impact, and inform payer negotiation strategies across the enterprise.

• Automation & Data Science: 

  • Create automated and functional dashboards and tracking mechanisms to display fee-for-service and value-base contract performance in real-time 

  • Support and collaborate in the development of claims based medical cost reports using third-party claims data to support outcome/risk-based performance objectives

  • Query and collate multiple complex datasets to create a data environment suitable for use by peers and department leadership

  • Provide expertise and support on proper aggregation and normalization of datasets from hospital systems, professional billing, pharmacy and third-party payors.

• Support the Managed Care Department in: 

  • Revenue cycle projects and process improvement studies

  • Develop skills and contribute to managed care contract review

  • Provide pricing support to Contract Managers to assist in their negotiation of Single Case Agreements

  • Interpret and analyze payer policy changes and create/ monitor associated impact assessments

 

• Proactively and appropriately escalate risks, issues, and decisions. 

• Builds strong cross-functional relationships within the organization including revenue cycle, ACO, clinical operations, and healthcare informatics, in addition to outside business units or affiliated organizations.

• Has excellent communication skills. Listens well, speaks and writes clearly and concisely. Present in front of a variety of potentially large audiences.

• Displays model behavior. Engages others to foster further development of AHS core values and mission.

Qualifications:

Education:

• Bachelor's degree in Healthcare or Business Administration, Public Health, Mathematics, Healthcare Informatics or Computer Science or similar subject
• Candidates with a Master’s in Health or Business Administration strongly preferred

 Requirements:

• 1 - 2 years of relevant experience preferred
• Knowledge of managed care financial metrics, including PMPM, utilization per 1,000, cost per unit, total medical expense (TME), percent of premium, and medical loss ratio (MLR).
• Experience analyzing healthcare claims, reimbursement, and financial data to identify trends, opportunities, and performance improvement initiatives.
• Proficiency in querying, extracting, and manipulating data using SQL.
• Experience using data visualization and analytics tools, such as Spotfire or similar platforms.
• Advanced proficiency in Microsoft Excel, including financial modeling, pivot tables, complex formulas, and data analysis; experience with Microsoft Access, VBA, or macros preferred.
• Experience supporting projects related to healthcare, revenue cycle, finance, analytics, information systems, or operational process improvement.
• Knowledge of Epic applications and healthcare information systems preferred.
• Epic Resolute Hospital Billing and/or Professional Billing Contract Administration experience preferred; certification required within 9 months of hire if not already obtained.