Valhalla, New York
Overland Park, Kansas
Los Angeles, California
Posted: 05-Mar-25
Location: Maitland, Florida
Categories:
Internal Number: 24040195
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Paid Days Off from Day One
- Student Loan Repayment Program
- Career Development
- Whole Person Wellbeing Resources
- Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Hybrid - 3 days at the office (Altamonte Springs,FL)
The role you’ll 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 AdventhHealth managed care to payers in all AdventHealth Markets.
The value you’ll bring to the team:
- Research and analyzes managed care data from the various financial systems and interface tools
- Performs analysis of complex and varied healthcare data including financial modeling and risk forecasting
- Work to identify/implement improvements in quality control/timeliness of reporting
- Extracts, collects, analyzes and interprets health utilization and financial data of various types
- Interpret an analyze data from various sources using knowledge of healthcare managed care contracts and healthcare administrative claims data
- Employs existing complex models and implements them on new projects and/or new contexts and she/he designs new solutions for data and analytic challenges the organization faces
- Support the negotiations of capitated and other VBA agreements between physicians/hospitals and payers/networks through detailed data analytics
- Develop financial models and inform VBA negotiations parameters and Evaluate possible changes to key terms in existing value based agreements
- Identify risk/exposure associated with various reimbursement structures. Produce prospective analyses an new venture, products, and service offerings
- Prepare and effectively present analytics or project results to key stakeholders for review and decision-making
- Evaluate and understand contract language as it relates to reimbursement methodologies for the full spectrum of app provider types
- Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II, DRG and revenue codes
- Demonstrates proficiency with various reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge
- Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators
- Ad-hoc reporting, management and intelligence related to large claimants, sequestration and healthcare exchange programs
- Accumulates data in logical format, interprets results, makes recommendations and influences outcomes
- Prepares well-organized project-specific documentation, that includes at a minimum, analytic methods used, ley decision points and caveats with sufficient detail to support comprehension and replication
- Leads in the development and review of the annual Managed care net revenue budgets to support the annual AdventHealth budget process
- Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance
- Demonstrates independent thinking and creativity in development of contract models, standard reports and ad hoc analyses
- Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by leadership
- Maintains a high degree of accuracy while using large amounts of data
- Participates in special projects and performs other duties as assigned
The expertise and experiences you’ll need to succeed:
Minimum Education Requirements
- Bachelor's degree in Finance, Health Care Administration, Accounting, Mathematics, or Health and Informatics or related field required
- Master's Degree in a related field preferred
- Minimum of four (4) years’ experience performing data, financial and/or risk analytics in a healthcare environment
- Working knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation strongly preferred
- Working knowledge of population health, utilization measurement, and claims analytics strongly preferred.
- Managed Care, Patient Financial services, health insurance claims processing, contract management, or medical economics required
- 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 required
LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
- Epic HB Certification required or must be obtained within first 6 months of hire
