Medical Economics Analyst

Complete Health; Jacksonville (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

Complete Health is seeking a Senior Medical Economics Analyst in Jacksonville, FL. The role focuses on Medicare Advantage and DCE membership reports, identifying new/termed members, and delivering data-driven insights to improve cost management.

Key duties include consolidating rosters from payers, analyzing demographics across systems, and collaborating with Value Based, Finance, and Market Clinical Operations teams to meet reporting needs.

Qualifications

• Bachelor's degree in Business, Health Care Administration, Mathematics, Finance, Health Informatics, or related field.
• Requires 4+ years of experience; healthcare-related experience preferred.
• Masters in relevant field preferred and can substitute for 2 years' experience.

Responsibilities

• Consolidates monthly patient rosters from payers and disseminates standardized list to various departments.
• Develops monthly process to identify new and termed members across data systems.
• Communicates with operational teams to meet data and reporting needs.
• Tracks business requirements from payers regarding cost reallocations and monitors case outcomes.
• Develops processes for identifying cost reallocation candidates and completes forms for payer submission.
• Obtains and analyzes data to improve processes, procedures and execution.

Skills

Communication skills

Microsoft Office

SQL queries

Tableau/BI tools

Data analysis

Healthcare data literacy

Education

Bachelor's degree in Business/Health Care Admin/Math/Finance/Health Informatics

Master's degree preferred

Tools

Tableau

Qlikview

Excel

Access

Job description

Position Type

Full Time

Shift

TBD

Pay Rate

TBD

Job Description

SUMMARY OF JOB DUTIES:

Senior Medical Economics Analyst will be responsible for working with Medicare Advantage and DCE membership files to produce panel reports, identify new and termed members, and other Medicare Advantage/DCE membership reporting.

ESSENTIAL JOB FUNCTIONS:

• Consolidates monthly patient rosters from payers and disseminates standardized list to various departments (Value Based, Finance, Market Clinical Operations, etc.).
• Develops monthly process to identify new and termed members and work across multiple data systems to consolidate demographic details.
• Communicates with operational teams to meet their data and reporting needs.
• Tracks business requirements from payers regarding cost reallocations and monitors case outcomes.
• Develops monthly processes and procedures for identifying candidates for potential cost reallocations and completes accompanying forms, if applicable, for payer submission.
• Obtain and analyze data to understand how to continually improve processes, procedures and execution.
• Maintain knowledge of current healthcare trends by reading appropriate literature and attending related conferences and/or seminars.
• Relied upon to apply business knowledge to analytics projects and provide value-added insights to directly impact business outcomes.

KNOWEDGE/SKILLS/ABILTIES:

• Excellent written and verbal communication skills and ability.
• Proficient in Microsoft Office such as Excel, Word, Access, etc.
• Experience in writing SQL queries preferred.
• Experience with using Tableau, Qlikview, or similar software preferred.
• Strong analytical, organizational, and problem-solving skills.
• Experience working with complex data sets across claims, lab, financial, clinical outcomes, and external sources.
• Knowledge of medical data structures including, but not limited to (ICD10, CPT, HCPCS, NDC)
• Knowledge of different reimbursement models (DRG, APC, AWP+, Cost plus, PDGM)

Requirements

MINIMUM REQUIREMENTS

• Bachelor's degree in Business, Health Care Administration, Mathematics, Finance, Health Informatics, or related field.
• Requires 4+ years of experience; healthcare-related experience preferred.
• Masters in relevant field preferred and can be substituted for 2 years' experience.

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