Analyst-Medical Economics

Summary

The Medical Health Economics Analyst conducts and interprets complex healthcare data analysis, including financial modeling and risk assessment. Supports contract negotiations and evaluates reimbursement structures through detailed analytics. Manages multiple projects, ensuring accuracy and timely completion while recommending improvements and presenting findings to stakeholders.

Responsibilities

• Research and analyzes managed care data from the various financial systems and interface tools.
• Performs analysis of complex and varied healthcare data including financial modeling and risk forecasting.
• Work to identify / implement improvements in quality control / timeliness of reporting.
• Extracts, collects, analyzes and interprets health utilization and financial data of various types.
• Interpret an analyze data from various sources using knowledge of healthcare managed care contracts and healthcare administrative claims data.
• Employs existing complex models and implements them on new projects and / or new contexts and she / he designs new solutions for data and analytic challenges the organization faces.
• Support the negotiations of capitated and other VBA agreements between physicians / hospitals and payers / networks through detailed data analytics.
• Develop financial models and inform VBA negotiations parameters and evaluate possible changes to key terms in existing value-based agreements.
• Identify risk / exposure associated with various reimbursement structures.
• Produce prospective analyses in new venture, products, and service offerings.
• Prepare and effectively present analytics or project results to key stakeholders for review and decision-making.
• Evaluate and understand contract language as it relates to reimbursement methodologies for the full spectrum of app provider types.
• Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9 / 10 CPT, CPT, HCPCS II, DRG and revenue codes.
• Demonstrates proficiency with various reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge.
• Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators.
• Ad-hoc reporting, management and intelligence related to large claimants, sequestration and healthcare exchange programs.
• Accumulates data in logical format, interprets results, makes recommendations and influences outcomes.
• Prepares well-organized project-specific documentation, that includes at a minimum, analytic methods used, ley decision points and caveats with sufficient detail to support comprehension and replication.
• Leads in the development and review of the annual Managed care net revenue budgets to support the annual budget process.
• Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance.
• Demonstrates independent thinking and creativity in development of contract models, standard reports and ad hoc analyses.
• Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by leadership.
• Maintains a high degree of accuracy while using large amounts of data.

Participates in special projects and performs other duties as assigned

Requirements, Preferences and Experience

Generally, requires 3 to 5 years of related experience

Bachelor's degree in Finance, Health Care Administration, Accounting or Health and Informatics or related field is required. Master's Degree in a related field preferred

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer :

Job Summary :

Position : 20294 - Analyst-Medical Economics

Facility : BMHCC Corporate Office

Department : HS Corporate Finance Admin Corporate

Category : Finance and Accounting

Type : Non Clinical

Work Type : Full Time

Work Schedule : Days

Location : US : TN : Memphis

Located in the Memphis metro area