Medical Economics, Financial Analyst

Position Focus :

In 1971, Yale University established Yale Health to provide health services to its facility, staff and students through a multidisciplinary health maintenance organization located on campus. Yale Health has over 49,000 members including students, staff, faculty and their families who come from every state in the country and almost every country in the world and is committed to an inclusive workplace. We are celebrating over 50 years of service to the Yale community.

Our state-of-the-art facility at 55 Lock Street, is where our members receive most of their care from our 150 providers. It is a 144,000 square foot medical facility with over 90 exam rooms, an Acute Care Department, a 15-bed inpatient facility with two negative pressure rooms, a diagnostic imaging suite including MR and CT scan, x-ray and ultrasound and a full-service retail pharmacy.

Reporting to the Manager of Medical Economics of Yale Health, support the detailed analysis and understanding of hospital, medical, and supplemental expenses covered by Yale Health Plan. Use analytical skills to monitor and report on trends, identify areas for contracting, and maximization of return on investment and contract compliance. Assist leadership in answering key business questions, modeling, and evaluating solutions. Support the Medical Economics departmental objectives for robust cost analysis and reporting. Under the direction of the Medical Economics Manager help identify opportunities for cost savings through in-sourcing, contracting, or modification of current contracts.

The ideal candidate will have a strong understanding of the insurance industry and a proven ability to navigate complex healthcare. Perform analysis and project work as requested.

Additional responsibilities include :

• Medical claims data and the health care industry, convert detailed data files into summarized actionable information. Incorporate benchmark data as available.
• In collaboration with other team members identify trends and variances requiring further analysis. Perform additional analysis to identify root cause of variances.
• Become familiar with and be able to use systems such as EPIC and IDX to investigate claims and utilization data.
• Understand and support the monthly analysis of IBNR (Incurred But Not Reported) reserve based on historical actuals and updates of actuarial analysis. Assist in the preparation of material for external auditors to review at year end. Make recommendations for changes to methods as required based on analysis.
• Under the direction of the Manager of Medical Economics assist in the review of annual premium costs per contract including the breakdown by student assessment, student supplemental, student Hospitalization / Specialty Coverage, student Prescription Plus coverage, employees, dependents, retirees, 19 plus, etc. Propose changes to management which would improve the alignment of costs with premiums if needed.
• Using data from claims files, as well as billing files, analyze current contract volume and costs; compare results to alternative pricing scenarios, propose options for pricing and / or terms and conditions to improve alignment with Yale Health goals.
• Provides analysis to determine present and future financial performance. Organizes information from a variety of sources for use in analyzing future plans and forecasts.
• Support efforts to report on subsets of Yale Health enrollment, such as union presentations for the HBET and similar customer-driven summaries for the University. Take initiative, validate data or report results. Ability to perform review for reasonableness and relevance.
• Support the fiscal responsibility of Yale Health leadership & perform special analysis as needed.

Dept / Section URL

Essential Duties

Financial Modeling and Forecasting. Provides technical analysis to determine present and future financial performance. Organizes information from a variety of sources for use in analyzing future plans and forecasts. Collaborates with all levels of management, both internally and externally, to gather, analyze, summarize, prepare, and present recommendations regarding financial plans and other complex financial matters. Researches and evaluates information to resolve issues and makes recommendations. Develops and / or executes complex financial models. Financial Analysis and Reporting. Analyzes and synthesizes information and designs and creates accurate and timely reports. Designs financial reporting to meet the compliance needs of internal and external users. Extracts and consolidates data from multiple sources. Financial Methods and Systems. Contributes to the planning and improvement of practices, processes and systems. Collaborates with all levels of internal and external contacts to carry out department goals. Provides a high level of service that cultivates and maintains strong working relationships and communicates effectively; takes ownership and accountability for timeliness, accuracy and relationship management. Strategic Resource. Translates department finance goals into objectives. Identifies and raises potential financial opportunities, issues, risks, ideas and solutions. Identifies the appropriate stakeholders to include in consultations, communications, approvals or buy-ins for designing and implementing changes. Compliance and Risk Management. Establishes, implements and / or maintains strong internal controls in areas of assigned responsibility to provide reasonable assurance of effective and appropriate resource use, accurate financial information, and adherence to contractual obligations and agreements, policies, procedures, and external regulatory requirements. Mentors, leads and / or supervises staff. May perform other duties as assigned.

Required Education and Experience

Bachelor’s degree in Accounting, Business, Economics or Finance and four years of related experience or an equivalent combination of education and experience. Demonstrated application of financial, accounting and economic concepts.

Required Skill / Ability 1 :

Knowledge of financial, health care related and economic concepts, accounting, financial theory, modeling and analysis & knowledge of Microsoft Office PC based spreadsheets, (Excel), word processing and database management (Access) software.

Required Skill / Ability 2 :

Related experience in Health Maintenance Organization (HMO) model and / or other Patient-Centered Care models. environments & demonstrated application of financial, accounting and economic concepts.

Required Skill / Ability 3 :

Ability to understand medical claims data and the health care industry & the ability to understand contract terms and conditions.

Required Skill / Ability 4 :

Familiarity of medical billing and coding as well as reimbursement methodologies & well developed organizational, oral, written communication, and presentation skills.

Required Skill / Ability 5 :

Ability to communicate complex information clearly and concisely to non-financial staff, physicians and managers & well-developed analytic and problem-solving skills.

Preferred Education, Experience and Skills :

MBA, CPA or MHA & Knowledge of health insurance industry.

Weekend Hours Required?

Occasional

Evening Hours Required?

Occasional

Drug Screen

Health Screening

Background Check Requirements

All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. For additional information on the background check requirements and process visit "Learn about background checks" under the Applicant Support Resources section of Careers on the It's Your Yale website.

Health Care Worker

This role is a healthcare worker position. Healthcare workers (HCW) are defined as university employees working a healthcare setting who have the potential for direct or indirect exposure to patients, human research subjects or infectious materials including body substance, contaminated medical supplies, devices and equipment, surfaces, or air. HCW have specific health requirements that must be met prior to starting work, including MMR vaccine or immunity, varicella (chickenpox) vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination.

Posting Disclaimer

The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the particular position. Employees will be assigned specific job-related duties through their hiring departments.