Sr Medical Economics AnalystMaitland, FL

Senior Medical Economics Analyst

Hospitals, medical centers and facilities need more than physicians, nurses and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady and experienced team working behind the scenes to make sure communities around the country receive the health care they need.

If you've also been interested in working in the health care field but aren't a health care provider, a corporate career at AdventHealth may just be the perfect fit. We're a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.

Start your journey with a health care career at AdventHealth Corporate.

Every day, our fellow team members show up to work, unified by one shared mission : Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

The role you will contribute :

A Senior Medical Economics analyst is responsible for analyzing and evaluating financial and economic data related to healthcare costs and managed care payer rates and reimbursement. The role focuses on financial trends, reimbursement methodology, data tools, modeling, and managing revenue. Must be able to complete extensive and complex financial and operational analyses of managed care contracts and proposals, analyze fee schedules, and determine contract compliance. The Senior Medical Economics analyst must have attention to detail and competencies in decision support and reporting through converting raw data into meaningful applications to support executive decision making. Character traits to include : Strong work ethic, trainability, communicative, team player, and strong analytical skills The Senior Medical Economics Analyst will work with managed care staff for both in the Florida and Multi-State Divisions of AdventHealth, as well as represent AdventHealth managed care to payers in all AdventHealth Markets.

The value you will bring to the team :

• Researches and analyzes managed care data from various financial systems and interface tools.
• Performs complex and varied healthcare data analysis, including financial modeling and risk forecasting.
• Identifies and implements improvements in quality control and timeliness of reporting.
• Extracts, collects, analyzes, and interprets health utilization and financial data.
• Interprets and analyzes data from various sources using knowledge of healthcare managed care contracts and administrative claims data.
• Employs existing complex models and implements them on new projects and contexts.
• Designs new solutions for data and analytic challenges faced by the organization.
• Supports negotiations of capitated and other value-based agreements through detailed data analytics.
• Develops financial models to inform negotiation parameters.
• Evaluates possible changes to key terms in existing value-based agreements.
• Identifies risk and exposure associated with various reimbursement structures.
• Produces prospective analyses on new ventures, products, and service offerings.
• Prepares and presents analytics or project results to key stakeholders for review and decision-making.
• Evaluates and understands contract language related to reimbursement methodologies for various provider types.
• Applies detailed understanding of medical coding.
• Other duties as assigned.

The expertise and experiences you'll need to succeed :

Bachelor's

Working knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation

Working knowledge of population health, utilization measurement, and claims analytics

Managed Care, Patient Financial Services, health insurance claims processing, contract management, or medical economics

Proficiency in understanding professional and facility claims and managed care concepts such as risk adjustment, capitation, FFS, DRG, APG, APCs and other payment mechanisms

Experience in modeling financial impact of changes

Strong ability to handle multiple projects including problem solving, research, analysis, and communication in a fast-paced environment

Intermediate level of proficiency working with MS Excel including Formulas, calculations, charts, and graphs

Strong skills in analytical / problem solving and presentations

Preferred Qualifications :

Master's

4 Work Experience

EPIC-Hospital Billing Certification (EPIC HB) Epic HB Certification

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category : Managed Care

Organization : AdventHealth Corporate

Schedule : Full-time

Shift : 1 - Day

Req ID : 25033829

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability / handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.