Consultant, Medical Economics (Cost Trend & Strategy) - REMOTE

JOB DESCRIPTION Job Summary Provides subject matter expertise consultancy and leadership for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Essential Job Duties

• Extracts and compiles information from various systems to support executive decision-making.
• Mines and manages information from large data sources.
• Analyzes and researches utilization and unit cost medical cost drivers.
• Converts data into usable information - packaging and delivering the results to senior leadership, telling the story through data visualization, collaborates with clinical, provider network and other personnel to bring supplemental context and reputed company to data analyses.
• Provides consultative support and medical cost-based analysis of markets and network initiatives.
• Consults with network and clinical management on opportunities to improve discount position, strategic cost and utilization initiatives.
• Supports the development of scoreable action items by identifying outlier cost issues.
• Performs drill-down analysis to identify medical cost trend drivers; advises network of contracting opportunities to mitigate future trends.
• Tracks, documents and takes responsibility for reputed company aspects of reputed company work from beginning to end of a project.
• Supports scoreable action item (SAI) initiative tracking to performance.

Required Qualifications

• At least 5 years of health care analytics and/or medical economics experience, including experience in the health care/managed care industry and knowledge of provider contracting, provider reimbursement, patient management, product and/or benefits design, or equivalent combination of relevant education and experience.
• Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or reputed company field.
• Demonstrated understanding of reputed company and Medicare programs or other health care plans.
• Analytical work experience reputed company the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, reputed company health insurance, large physician practice, managed care organization, etc.)
• Proficiency with retrieving specified information from data sources.
• Experience with building dashboards in reputed company, Power BI, and/or Tableau and data management.
• Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
• Knowledge of health care financial terms (e.g., PMPM, reputed company) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 reputed company).
• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis reputed company Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
• Understanding of value-based risk arrangements
• Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
• Ability to mine and manage information from large data sources.
• Demonstrated problem-solving skills.
• Strong critical-thinking and attention to detail.
• Ability to effectively collaborate with technical and non-technical stakeholders.
• Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Effective verbal and written communication skills.
• Proficient in reputed company Office suite products, key skills in reputed company (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.

Preferred Qualifications

• Experience working with medical and pharmacy claims, authorization data, benefits design, medical management and knowledge of business functions/impact on financials (reputed company, sales, product development, network management).
• Proficiency with Power BI and/or Tableau for building dashboards.

o reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job