Healthcare Economics Analyst II

Our Values

About the Role

Provides decision support and recommendations to management through detailed and complex analyses of healthcare trends, measurement of corporate financial performance, and quantification of the impact or effectiveness of projects and corporate programs. 

To be successful in this role, you:

• Have a minimum two (2) years’ experience analyzing healthcare claims/encounter data, four (4) years preferred.
• Have knowledge and experience with advanced analytic features of SQL, Access and Excel.
• Have broad experience with managing and modeling of large data sets.
• Possess a Bachelor’s degree in a quantitative discipline such as Mathematics, Statistics, or Economics, or related field (preferred)

Essential functions and Roles and Responsibilities:

• Estimates medical and pharmacy claims expenses, including reserve requirements.
• Identifies, monitors, and analyzes principal health care cost drivers, by market segment and/or by provider, including utilization, referral patterns, and reimbursement rates.
• Prepares provider pool settlements, including monthly calculation and annual distributions.
• Provides decision support for department, including data requests for financial statements accruals, bids, and budget.
• Participates in budget development and capitation rate development. Assists Provider Contracting with annual rates update.  Reviews and verifies system set-up of annual rates update.
• Supports projects/initiatives owned by Healthcare Economics that span departments.
• Conducts complex quantitative analyses using tools such as SQL, SAS, Access, Excel.
• Exhibits initiative in exploring and discovering opportunities to improve corporate performance through data analysis.
• Presents analyses/reports in clear and useful format to management and colleagues in other departments.
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Knowledge of healthcare coding conventions such as ICD-10, CPT & HCPCS.
• Familiarity with externally available datasets to use for comparative analysis (i.e. DOH, CMS, HCA, Milliman, HRSA)
• Knowledge of healthcare reimbursement methodologies including capitation, DRG, case rates, outlier methodologies, APCs and CAH.
• Experience with Medicaid, Medicare Advantage, Public Option plans, and/or Community Health Centers.
• Excellent oral and written communication skills.
• Strong customer service skills.
• Ability to interpret healthcare data and effectively present sophisticated analyses and findings to diverse audiences.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 70 and has a 10% annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents: 

•  Medical, Prescription, Dental, and Vision
•  Telehealth app
•  Flexible Spending Accounts, Health Savings Accounts
•  Basic Life AD&D, Short and Long-Term Disability
•  Voluntary Life, Critical Care, and Long-Term Care Insurance
•  401(k) Retirement and generous employer match
•  Employee Assistance Program and Mental Fitness app
•  Financial Coaching, Identity Theft Protection
•  Time off including PTO accrual starting at 17 days per year.
•  40 hours Community Service volunteer time
•  10 standard holidays, 2 floating holidays
•  Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.

Mental:

• Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.