Senior Medical Economics Analyst

7 days ago

Orlando, Florida, United States Valora Medical Group Full time
Job Summary

The Senior Medical Economics Analyst will be responsible for leveraging advanced analytical skills to support strategic initiatives and operational improvements within our Primary Care Group.

This role requires expertise in medical economics and healthcare data analysis, with a focus on utilization KPIs, Medical Risk Adjustment (MRA), Medical Loss Ratio (MLR), and Service Fund data management and reporting.

Key Responsibilities
  • Utilization Analysis
    • Monitor and analyze key performance indicators (KPIs) related to healthcare utilization, including:
    • Visit Frequency: Analyze patterns in patient visit frequency to identify opportunities for optimizing care delivery.
    • Service Utilization Rates: Evaluate the usage rates of various services to ensure efficient resource allocation.
    • Admission Rates: Track hospital admission rates and readmission rates to assess the effectiveness of care management programs.
  • Risk Adjustment
    • Apply knowledge of Medical Risk Adjustment (MRA) to evaluate and adjust financial risk profiles:
    • Risk Scores: Analyze and interpret risk scores to support accurate risk adjustment and ensure appropriate resource allocation.
    • Documentation: Ensure comprehensive documentation and coding practices to capture patient acuity and risk accurately.
  • Medical Loss Ratio (MLR) Analysis
    • Monitor and analyze MLR to ensure compliance with financial targets:
    • Expense Tracking: Track and report on medical expenses relative to premiums to assess the efficiency of care management.
    • Compliance: Ensure adherence to MLR requirements and identify strategies to optimize MLR performance.
  • Service Fund Data Management
    • Oversee the data loading and reporting of Service Fund data:
    • Data Consolidation: Combine Service Fund from different payor sources.
    • Reporting: Generate detailed reports on Service Fund utilization, including insights into trends and areas of opportunities.
    • Analysis: Evaluate the impact of Service Fund spending on overall financial performance and patient care outcomes.
  • Data Interpretation
    • Develop and maintain economic models to project financial impacts of various scenarios, including policy changes and reimbursement adjustments.
  • Reporting and Visualization
    • Create and present detailed reports, dashboards, and visualizations to communicate findings and support decision-making.
  • Benchmarking and Best Practices
    • Conduct benchmarking studies to compare performance against industry standards and implement best practices to drive improvement.
  • Strategic Support
    • Collaborate with cross-functional teams to provide data-driven recommendations for strategic planning and operational improvements.
Requirements
  • Bachelor's degree in Computer Science, Finance, Health Services Research, or a related field; Master's degree or advanced certification preferred.
  • Minimum of 5 years of experience in medical economics, healthcare analytics, or a related field. Experience in a primary care setting is highly desirable.
  • Proficiency in data analysis tools and software (e.g., SQL, Excel, R, SAS, or Python). Strong Relational DB analysis and design experience.
  • Strong SQL knowledge.
  • Strong analytical and problem-solving skills with the ability to interpret complex data related to utilization, MRA, MLR, and Service Fund management.
  • Excellent communication skills, both written and verbal, with the ability to present findings to diverse audiences.
  • Strong organizational skills with the ability to manage multiple projects and deadlines.
  • Practical knowledge of eClinicalWorks EBO.
  • Highly proficient with database analysis and design
  • Highly proficient with SQL and ETL
  • Advanced MS Excel skills for data analysis, presentation preparation, and reporting
  • Project Management Certification is a plus
  • Proven ability to develop and execute programs and processes
  • Ability to make decisions in a timely fashion that are sound, accurate, and supported by the reasoning and inclusion of the appropriate people
  • Must be able to prioritize and accomplish objectives at an acceptable level
  • Ability to establish working relationships, resolve interpersonal conflicts, and apply basic staff etiquette in dealing with others
  • Ability to handle confidential information with discretion
  • Ability to learn new procedures and adapt quickly to change
  • Innovative, motivated, organized, and team player
  • Follow through with commitments
  • Ability to work independently
  • Proactive and self-starter
Equal Employment Opportunity

Valora Medical Group, LLC is an equal opportunity employer and does not discriminate on the basis of race, color, religion, creed, sex, national origin, age, disability, pregnancy status, sexual orientation, gender identity, veteran status, marital status, genetic information, citizenship status, or other status protected by law.

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