Senior Medical Economic Analyst

Role overview:

This role is responsible for analyzing and evaluating financial and economic data related to healthcare costs, managed care payer rates, and reimbursement. It focuses on identifying financial trends, applying reimbursement methodologies, leveraging data tools, and developing financial models to manage revenue effectively. The position involves conducting complex analyses of managed care contracts and proposals, reviewing fee schedules for compliance, and transforming raw data into actionable insights to support executive decision-making. Additionally, the role ensures collaboration with managed care teams across multi-state divisions and represents the organization in discussions with payers across various markets.

Job Description:

• 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.

Key Responsibilities:

• Build and analyze reimbursement rate structures for upcoming years.
• Pull 1–2 years of historical data and use Excel to model trends and methodologies, including stop-loss and per diem models.
• Forecast future reimbursement rates and financial impacts based on historical data, market trends, and modeling assumptions.
• Financial Analysis: Evaluate monetary impacts and account-level details to support decision-making.
• Contract review and interpret payor contract language and translate reimbursement terms into formulas for financial modeling.
• Stay informed on market insights of active contracts and payor trends to guide negotiations and rate-setting strategies.