Advisor, Medical Economics

2 months ago

Nashville, United States ArchWell Health Full time
Advisor, Medical Economics Nashville, TN, USA * Virtual Req #12127 Sunday, November 17, 2024

ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities.

Job Summary:

The Advisor, Medical Economics will play a key role in supporting analytical needs across ArchWell Health's Operations, Clinical, and Finance teams. This will be a colleague who is motivated by the challenge of answering complex medical economics questions using a variety of data sources. This is a fast-paced position that will enable high-quality personal development and growth.

Duties/Responsibilities:

  • Identify, monitor, and analyze principal health care cost drivers, by market segment and/or by provider, including utilization and referral patterns and reimbursement rates
  • Research healthcare delivery topics, analyze data, present results, and recommend solutions to address business challenges by applying knowledge of medical claims analysis, critical-thinking skills, and healthcare experience/expertise
  • Analyze claims, membership, and prior authorization data to identify early signs of trends or other issues related to medical care costs and quality of care
  • Provides actuarial support for Medicare Advantage plans by identifying trends and profitability drivers utilizing sound statistical methods.
  • Utilizes experience with HCCs and RAFs to forecast revenue projections
  • Structure analytical results in an organized, visual manner to tell a meaningful, actionable story
  • Work with Engineering team to source data, determine its credibility and usability, create end-user reports, and apply varying analytical techniques to solve specific business problems
  • Perform ad-hoc requests from key stakeholders
  • Interpret contractual language with a clear understanding of business rules and reporting requirements
  • Execute other duties and special projects as needed, focusing on knowledge and skills development

Required Skills/Abilities:

  • You enjoy independent research and presenting solutions to complex problems
  • You work both collaboratively and independently to complete complex analyses, leading to actionable strategic and financial business decisions
  • You apply strong critical thinking skills to anticipate questions from key stakeholders and consider all aspects of an analysis before completion
  • You exhibit initiative in exploring and discovering opportunities to improve company performance through data analysis
  • You establish trusting, professional relationships with internal, senior stakeholders

Education and Experience:

  • Bachelor's degree in Applied Math, Statistics, Actuarial Science, Economics, or a related field required
  • 4+ years of prior experience as an analyst with a health plan, ACO, RBE, or consulting firm focused on health economics
  • Expertise in MS Excel, including proficiency using formulas, PivotTables, PowerBI, graphing and other reporting and presentation features
  • Experience working with internal groups, including IT, to procure necessary datasets preferred
  • Experience in data mining working with large data repositories and/or relational databases with SQL experience strongly preferred
  • Experience creating product trend analyses using statistically valid methodologies

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

Other details
  • Job Family Operations
  • Pay Type Salary
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