Senior Medical Economics Analyst, Value-Based Care
axialHealthcare is seeking an experienced, healthcare analyst with strong SQL /R skills, who can provide enterprise-wide technical, operational, reporting, and analytical expertise. The successful candidate will play a pivotal role in shaping the future direction axial Healthcare’s next generation solutions, provider profiling, and quality measurement solutions to successfully navigate the transition to a value-based healthcare system, as well as support potential new markets. This role will partner with a diverse and highly talented team of product owners, data analysts, technology architects and engineers to define and execute on new product development from inception to launch. The successful candidate will be extremely analytical, demonstrate health care industry knowledge and experience, and health care data analytics domain expertise as well as bring a unique blend of leadership, creativity, business judgment, entrepreneurial spirit to the table.
- Drive analytics and pricing within the value-based healthcare analytics domain through a deep understanding of customer needs and where the market is headed
- Develops and maintains expert level of knowledge on risk segmentation, episodes of care, bundled payments, and other industry-specific metrics
- Leads or participates on complex medical economic projects related to Bundled Payments or Value-Based initiatives. Accountable for all analytic iterative scenario based modeling and financial projections associated with new strategic initiatives
- Designs and conducts analyses to evaluate the overall effectiveness of Axial’s core programs including achieving financial and utilization goals. Develop data queries, conduct rigorous analyses using appropriate statistical methods, interpret results and present findings to leadership.
- Develop and maintain savings models that account for risk adjustment, continuous enrollment, seasonality, trends, etc
- Develop intimate knowledge of customer nuances, regional variations, legislative changes etc that can be leveraged in analytical value delivery. Establish and maintain effective relationships with customers and gain their trust and respect.
- Support efforts to design, implement, and execute alternative payment arrangements and risk/incentive structures with customers.
- Analyze and interprets cost and utilization data, identify key drivers, and underlying issues, perform appropriate drill down queries, summarizes, present and translate findings into meaningful information and actionable results.
- Assist in quality control analysis to ensure client satisfaction and performance guarantees are met and/or exceeded.
- Produce ad hoc, monthly, quarterly and annual reports and analyses.
- Execute prospective client analyses with focus on identifying specific opportunities and assisting related business development activities.
- Monitor the accuracy, completeness and validity of reporting prior to distribution and ensure the integrity of data through ongoing analysis.
- Collaborate with the Data Warehouse team on the data architecture necessary to support recurring and ad-hoc claims-based financial impact analyses
- Bachelor’s Degree, required, Master’s Degree, preferred
- 5+ years of experience working as an analyst, healthcare industry strongly preferred
- Medical cost savings experience in a health plan, strongly preferred
- Successful completion of 1 or more actuarial exams is a plus
- Analytical experience with claims, provider, eligibility, and related data is critical
- Expertise in developing complex, legible and well-structured scripts and queries in SQL, SAS or R
- Exposure to/experience across payer, provider, government, and employer (direct & channel), perspectives, preferred
- Familiarity with risk-adjustment and predictive modeling methodologies and other products, preferred
- Prior pricing analysis experience, preferred
- General knowledge of health policy, Medicaid and Medicare
- Experience in data mining and analytic data transformation
- Experience working with large data repositories and/or relational databases
- Advanced analytic skills with the ability to analyze and interpret data through complex analysis
- Ability to work on multiple projects simultaneously with minimal supervision
- Excellent computer skills, strong leadership qualities, organization, and project management skills
- Ability to quickly adapt to changes in both technology and business environments
- Ability to analyze data and apply investigative skills in resolving issues
- Strong customer service and positive attitude
- Highly self-motivated and directed with keen attention to detail
- Experience with BI Toolsets and multiple SQL dialects, preferred