What are the responsibilities and job description for the Medical Economics Consultant position at AmeriHealth Caritas?
Responsibilities
The position of Medical Economics Consultant reports to the Manager of Medical Economics & Business Process within Actuarial Analytics. This position is primarily responsible for developing large reporting layers, reports, executive decks, & enhanced metrics for our Total Cost Of Care (TCOC) revenue & expense review process. Additional responsibilities include meeting the business on actionability from insight by helping develop High Value Opportunities (HVO’s) that are in the millions of dollars in savings / revenue added & validating ongoing initiative savings methodology & accounting. Consultants have technical backgrounds & will create tools & reports that draw on disparate datasets and follow departmental infrastructure & practices in order to generate a complete picture of our medical expense & revenue trends for primarily Medicaid by member cohort & claim category through the use of industry-standard KPI. Consultants are expected to work with operational matrix partners to understand business processes in place to ensure reporting relevancy in addition to presenting findings to leadership in a clear & concise manner. Technology competencies include Azure Databricks, SAS, Python, MS SQL Server, Tableau, MS Power BI, Excel Data Models, or equivalent technologies.
Education / Experience :
- Bachelor’s Degree in Actuarial Science, Economics, Computer Science, IT, IS, or a related field strongly preferred OR equivalent combination of education and work experience will be considered.
- 1 to 3 years experience working in Medical Informatics, Medical Economics, or related analytical positions at Managed Care Organizations.
- Excellent communication skills
- Understanding of enterprise approaches to either MS SQL Server & related RDBMS technologies or MS Azure & related cloud computing data lake solutions
- Mastery of SQL
- Experience creating mega reporting projects & associated infrastructure from master data layers to enhanced clinical metrics that drive action.
- Strong knowledge of the anatomy of healthcare claims and / or encounters
- Strong knowledge of health informatics terminology & classification schemes, i.e., CPT codes, ICD-10 dx, common groupers like DRGs, CCS, etc.
- Strong knowledge of industry-standard population health & quality KPIs, i.e., utilization per thousand, readmission rates, HEDIS metrics, etc.
- Strong knowledge of Excel
- Experience in a visualization tool like Power BI or Tableau
- Some knowledge of SAS or Python
- Strong interest in Medicaid
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable being themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
Generous paid time off and paid volunteer time off.
Employer-matched 401(k) and additional non-elective contributions, starting on day one.
Medical, dental, and vision plans — with coverage starting on day one.
Employee assistance programs, fitness reimbursements, nutrition counseling, and more.
Employer-paid life insurance, with opportunities to purchase additional coverage.
Employer-paid short-term disability coverage and long-term disability coverage.
Tuition assistance, including reduced tuition at certain schools.
Financial assistance with adoption, including paid time off.
Flexible spending and health savings accounts to pay for qualified expenses.
Discount programs on entertainment, travel, and more.
