Medical Economics Analyst – Remote

Presbyterian Healthcare Services; Albuquerque (NM); Remote; Full time

Job summary

A healthcare organization in Albuquerque, New Mexico is seeking a skilled Medical Economics Analyst to analyze medical data and report savings. The ideal candidate will hold a Master’s degree with four years of experience in the healthcare industry, particularly in medical economics. Responsibilities include using SAS for data analysis and collaborating with the Payment Integrity team. The position offers a competitive salary and is open to remote applicants within the U.S., with some restrictions on states.

Benefits

Comprehensive benefits package

Employee Wellness Rewards Program

Qualifications

• Four years healthcare industry experience, specifically medical economics.
• Masters degree is preferred.
• Two or more SOA exams passed is preferred.

Responsibilities

• Use SAS to generate claim lines either denied or price adjusted.
• Work closely with Payment Integrity team in validating savings.
• Recommend and implement processes used in reporting.

Skills

SAS

Claim Procedure Coding

Effective writing and oral communication skills

Advanced skills in MS Excel

Risk Share Arrangements

Education

Bachelor's degree in healthcare, accounting, finance or related fields

Master's degree

Tools

Oracle SQL

Tableau

Business Objects

Job description

Overview

Presbyterian is seeking a Medical Economics Analyst. This position will play a consultative role in analyzing medical data, specializing in reporting savings for payment integrity related processes, including pre-payment claim edits, pricing adjustments, and other cost-reduction initiatives. Reconciliation to vendor invoicing to ensure appropriate fee payments will also be integral to the role, along with creating and modifying SAS-based solutions for these processes. Will be required to perform financial impact quantifications and projections of financials including layering into budget and forecasts. Develop new approaches and investigate different modelling avenues and varying data sets. Ownership of quantification processes including reporting various perspectives of impact within an integrated delivery system.

Responsibilities

• Use SAS to generate claim lines either denied or price adjusted in a consolidated dataset
• Work closely with Payment Integrity team in validating savings and diagnosing potential discrepancies with vendor invoices
• Recommend, implement, and oversee maintenance of processes used in reporting and reconciliation
• Provide support in development of reports as needed
• Claim Pricing & Provider Reimbursement: fee schedules and Pricing Systems
• This is a Full Time position – Exempt: Yes
• Remote: Open to remote applicants in the United States, except for the following states: California, Illinois, North Dakota, New York, Ohio, Washington and Wyoming
• Work hours: Days

Ideal Candidate

• Masters degree
• Four years healthcare industry experience, specifically medical economics

Qualifications

• Bachelors degree in healthcare, accounting, finance or other quantitative/related fields. Masters degree is preferred.
• Four years healthcare industry experience, specifically medical economics / product performance analyzing
• Claim Procedure Coding: CPT/HCPCS, ICD DCS PCS, DRG
• Claim Provider Coding: Bill Type, POS, Provider Types
• Benchmarking
• Risk Share Arrangements: Capitation, Shared Risk/Savings/Penalty, Quality Bonuses
• Provider/Vendor Contracting Analysis
• Claim Pricing & Provider Reimbursement
• Program/Project Pricing & Savings Valuation
• IBNR
• Forecasting/Projection/Budget
• Pricing (eg., Commercial small group/large group/individual)
• Benefit Change Determination/Pricing
• Rate Filings: Exhibits, Templates, Support
• Risk Adjustment/Risk Models (HCC, HIX, Commercial Products)
• Effective writing and oral communication skills
• Advanced skills in MS Excel, Access, PowerPoint, Oracle SQL, and Business Objects
• Two or more SOA exams passed is preferred
• Tableau, SAS Enterprise Guide, and VBA programming knowledge and experience is preferred

Benefits

About Presbyterian Healthcare Services: Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits. The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities – like challenges, webinars, and screenings – with opportunities to earn gift to earn gift cards and other incentives. As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers’ markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Maximum Offer for this position is up to: USD $56.92/Hr. Compensation Disclaimer: The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.