Medical Economics Resume Samples

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O Rowe

Oma

Rowe

500 Luettgen Trafficway

Philadelphia

+1 (555) 524 0969

500 Luettgen Trafficway

Philadelphia

Phone

p +1 (555) 524 0969

Experience Experience

Houston, TX

Medical Economics Analyst

Houston, TX

Baumbach LLC

Houston, TX

Medical Economics Analyst

Working with all relevant stakeholders, produce analytics across a variety of subject matters including medical and quality management, network management, contracting, and new business development
Produce and monitor monthly trends in cost and utilization and quality metrics to explain drivers of financial results and highlight areas of opportunity for implementation of data-driven solutions to favorably impact medical costs and quality improvement
Utilize BI tools in designing dashboards, scorecards, and reports to track key healthcare quality and efficiency metrics by Risk Unit, practice, physician and care management program. Communicate findings of performance trends and identification of areas of opportunity for performance improvement
Provide ad hoc analytical support to other departments such as Contract Management, Medical Management, and Vendor Oversight
Develop various sensitivity analytics to assess financial exposure based on changes to business and contractual methodologies
Act as a support resource for provider performance reporting and report development and interpretation to understand medical cost, utilization and corresponding trends
Provide ad-hoc analytical support to other departments such as Contract Management, Medical Management, and Vendor Oversight

Detroit, MI

Medical Economics Informatics Specialist

Detroit, MI

Braun, Koss and Von

Detroit, MI

Medical Economics Informatics Specialist

Assist in local market planning process focusing on the expansion of Fee For Value arrangements with Cigna contracted providers
Develop and improve financial accounting, analysis and forecasting methods
Create and manage quarterly CCC Reserves including projections and adhoc reporting
Work closely with Provider Contract Database Analyst to maintain accuracy of forecasting tools
Manage Reserves for California Special Programs and provide detailed information to other units for related Cigna initiatives such as 50/90 reporting
Develop and improve reporting processes and documentation for quarterly reports, RFP requests, etc
Support completion of new business proposals (e.g. RFPs) by providing value based financial analysis, metrics, and insights

present

Philadelphia, PA

Medical Economics Informatics Senior Specialist

Philadelphia, PA

Dooley-Cole

present

Philadelphia, PA

Medical Economics Informatics Senior Specialist

present

Work with contracting/MME to develop strategies to accelerate the signing of FFV contract
Be a liason between Cigna and the group to provide analytical support at negotiation of new FFV contracts
Show providers value of our programs and how to succeed in partnership with Cigna
Change leader who will be proactive in assisting in positive growth for the future
Dive deeper than ever before into data
We are looking for a very technically oriented individual to join our technical team
Build strong relationships with individuals by demonstrating the power of the informatics our group is doing

Education Education

Bachelor’s Degree in Finance

Iowa State University

Bachelor’s Degree in Finance

Skills Skills

Strong time management skillswith the ability to multitask concurrent priorities in an organized manner
Strong computer skills with demonstrated proficiency in Microsoft Office applications
Detail oriented with strong analytical and organizational skills
Ability to communicate complex quantitative analysis in a clear, precise, and actionable manner
Understanding of the variables and/or components that comprise Medicare Advantage and Medicaid premiums
Understanding of medical claims and the components and variables that affect the nature of payment reimbursement
Strong oral and written communication skills to effectively communicate with all levels of management
Ability to effectively interpret data and communicate findings/recommendations both orally and in writing appropriate to the audience
Ability to take direction from and communicate effectively with senior management and medical directors on a daily basis
A strong focus on process improvement and a proven track record of prior improvements

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13 Medical Economics resume templates

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Medical Economics Analyst, Senior Resume Examples & Samples

Proactive involvement with identification, evaluation and monitoring of medical cost savings initiatives
Bachelor's degree (B. A.) from four-year college or university
Graduate degree and/or significant industry experience
Significant experience with SAS Enterprise Guide, Business Objects or other graphical business intelligence tools
Superior analytical skills required
Superior ability to define problems, collect data, establish facts, and draw valid conclusions
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables
Knowledge of Word sufficient to create complex documents which may contain graphics, form fields, sub-headings and indexes
Knowledge of Excel sufficient to create complex spreadsheets containing functions, if statements, look-up tables and macros
Knowledge of database concepts and designs
Knowledge of email systems such a Microsoft Outlook sufficient to communicate with both internal and external contacts
LI-BB1

Medical Economics Informatics Senior Specialist Resume Examples & Samples

Build strong relationships with individuals by demonstrating the power of the informatics our group is doing
Acts as catalyst through multiple layers to spark enthusiasm, collaboration and results. Never use the term “that’s how we always done it”
Bachelor’s Degree or commensurate experience. Finance, Economics, Mathematics preferred, Clinical/Current Medical Coding and/or Public Health training a plus. Actuarial experience welcome but not required
Financial/Clinical Experience (4-6 years minimum) in the managed care industry or Public Health Care; clinical/medical coding knowledge and experience
Demonstrated ability creating professional relationships
Effectively partner with and influence a cross-functional team

Medical Economics Analyst Resume Examples & Samples

3+ years business decision support or financial analytical support using SQL, SAS, MS Access and frontend reporting tools (SSRS, Excel, MS Access, Tableau, etc.)
Advanced Excel skills (complex formulas, pivot tables, dynamic visualizations, VBA, macros) required
Strong knowledge of Medicare/Medicaid programs or financial reporting in the health insurance industry
Ability to effectively interpret data and communicate findings/recommendations both orally and in writing appropriate to the audience
Ability to utilize database technology to effectively query data and generate reporting analyses for senior management and medical directors
Ability to read and interpret financial statements and understand the economic drivers relevant to the managed care industry
Understanding of medical terminology as it pertains to managed care data environment including but not limited to: ICD-9, ICD-10, CPT-4, DRGs and risk adjustment
Understanding of the managed care industry as it pertains to insurance, physician groups, risk contracting and incentive arrangements
Understanding of medical claims and the components and variables that affect the nature of payment reimbursement
Understanding of premium and funding as it pertains to physician group contracts
Understanding of the variables and/or components that comprise Medicare Advantage and Medicaid premiums
Ability to take direction from and communicate effectively with senior management and medical directors on a daily basis
A strong focus on process improvement and a proven track record of prior improvements
In-depth knowledge and understanding of the various types of contractual relationships payors may have with providers, including global risk, capitation and risk-sharing arrangements
Organizational and project management skills to manage projects effectively; ability to manage multiple projects simultaneously
Exercises self-awareness; monitors impact on others
Receptive to and seeks out feedback; uses self-discipline to adjust to feedback
Ability to conduct analytic work in an efficient manner with minimal re-work including effective use of the peer review process
Excellent verbal and written communication skills; outstanding interpersonal skills; the ability to relate positively with individuals at all levels both internally and externally

Senior Dir, Medical Economics Resume Examples & Samples

2) Provides cross-functional leadership in designing, developing, and assessing local, regional, and national strategic Health Care Delivery initiatives
3) Tracks business results and captures critical information for financial accountability and support for performance management team
4) Oversees the development of analytical tools and models
5) Designs and oversees the design of effective processes for achieving business goals
6) Participates in the evaluation of product design and its impact on medical cost
7+ years experience in a health care delivery system role with accountability for business results
3-5 years experience with Medicare products
Extensive experience in the managed care industry with an in-depth knowledge of health care analytics and tools

Medical Economics Informatics Manager Resume Examples & Samples

Responsible for rethinking Fee-For-Value (FFV) reserving and reporting
Creating more transparency with our clients on current and future methodologies around FFV payments
Create opportunities for Cigna and its clients to better understand performance of FFV programs
Dive deeper than ever before into data
Never use the term “that’s how we always done it”
Collaborate each and every day with known matrix partners and those yet to be discovered
Acts as catalyst through multiple layers to spark enthusiasm, collaboration and results
Clinical/Current Medical Coding and/or Public Health training a plus
Minimum 10 years of Financial/Clinical Experience in the managed care industry or Public Health Care
Entrepreneurial Mindset
Demonstrated excellence in leadership ability to engage and motivate in a high performance culture
Strategic thinker with both sound and broad business acumen
Experience working successfully in a matrix environment

Medical Economics Informatics Specialist Resume Examples & Samples

Assist in local market planning process focusing on the expansion of Fee For Value arrangements with Cigna contracted providers
Create quarterly, annual, and five year forecasts of medical cost spending and savings
Conduct variance analysis at the local market level of savings estimates vs. plan
Review forecasts and variance reports with local markets as needed and answer any questions around assumptions and the planning process
Update P&L statements quarterly with latest historical and forecast data and share with matrix partners
Develop and improve financial accounting, analysis and forecasting methods
Develop and update quarterly and ad hoc reports for local markets and sr. leaders
Bachelor’s Degree strongly preferred; Finance, Economics, Mathematics preferred,
MBA, CPA or advanced degree in statistics is a plus
Actuary experience welcome but not required
Financial Experience (4 years minimum) and experience in the managed care industry or Public Health Care (2 years minimum) strongly preferred
Proven skill in understanding individual market dynamics (healthcare providers, employers, and competitors, skill/experience in quality/payment innovation programs, health plan performance, etc.) to set strategies/tactics to achieve both cost and quality objectives
Knowledge of both the PPO and managed care environments, including product offerings, competitor offerings and healthcare provider value based reimbursement programs helpful
High proficiency with PC and software applications, including Microsoft Word, Excel, and Access
Experience with data analysis, pivot tables, filters, vlookups
Experience using excel for forecasting and variance analysis
Familiar with financial concepts such as ROI and cost benefit analysis
SQL or SAS coding experience desired but not required. Will be expected to learn
Tableau development experience a plus

Medical Economics Informatics Senior Specialist Resume Examples & Samples

We are looking for a very technically oriented individual to join our technical team
Reporting development experience with Excel, Powerpoint, Access
Automation of reports a plus
Advanced experience with SAS, SAS Macros, SQL, SQL automation
SAS Certified a plus
Experience with Tableau preferred
Experience with VBA preferred
Bachelor’s degree preferred; or commensurate experience

Medical Economics & Actuary Services Supervisor Resume Examples & Samples

Supervise a unit of employees in the Medical Economics team in the development of monthly dashboard reporting, with contributions toward the monthly trending, and assistance in ad hoc financial analysis
Ensure staff are on track and focused on goals
Manage the financial analysis work load
Work with Director to set priorities and reasonable deadlines
Develop ongoing dashboard reporting
Extract and analyze data for Medical, Network Department and Executive Team
Extract and analyze data for Contract Changes
Provide monthly trending of Revenue, Member Months and Medical Costs
Complete monthly and quarterly financial reports, and financial analysis projects in timely and accurate manner
At least two (2) years working in a managed care environment
At least five (3) years in healthcare financial management or related field
At least two (1) years supervisory experience

Medical Economics Analyst Resume Examples & Samples

Medical Economics report development and analytics
Technology Solutions Expert: SuperUser of Medical Economics technology and analytical solutions used for Medical Economics data and reporting
Operation and maintenance of Medical Economics reporting
1+ years experience in an analytical role with an analysis firm or large company utilizing heavy data management components and performing independent analysis

Senior Medical Economics Analyst Resume Examples & Samples

Medical economics report development and analytics
Consultation and Education
Provide guidance and training to Medical Economics Analyst
Operation and Maintenance of Medical Economics Reporting

Medical Economics Informatics Specialist Resume Examples & Samples

Financial Reporting and administration of California IHA Pay for Performance (P4P) program including financial model improvements and implementation, understanding new/proposed changes to program, and presenting data to stakeholders and provider groups
Facilitate incentive program payments to Provider Organizations
Manage Reserves for California Special Programs and provide detailed information to other units for related Cigna initiatives such as 50/90 reporting
Manage Risk Share arrangements including all financial reporting and data analytics and engaging matrix partners such as Accounting, Contracting, Sales, and Medical Management as needed
Provide data governance services including validation, reconciliation and transmission to third party vendor
Create and manage quarterly CCC Reserves including projections and adhoc reporting
Conduct variance analysis of combined fee for service and encounter claims for Employer Groups and Provider Organizations leveraging Tableau application
Develop and update quarterly and ad hoc reports for local markets and Sr. leaders
Bachelor’s Degree strongly preferred; Finance, Economics, Mathematics preferred
Financial Experience and experience in the managed care industry or Public Health Care strongly preferred
SQL or SAS coding experience required

Senior Analyst, Medical Economics Resume Examples & Samples

Conducts complex and critical studies and analyses
Verifies, processes, analyzes and reports on key performance indicators and other data critical to the organization
Develops and maintains data visualizations and presentations of the KPIs
Reports results monthly, quarterly, year to date or year/year on departmental requests, as directed
Tracks, researches and reports statistical variances. Identifies and investigates issues
Designs, develops and modifies systems and procedures to enhance departmental processing, as needed
Supports Analysts and other staff in completion of projects and duties
Troubleshoots problems and researches variance causation. Interprets data and recommends appropriate course of action
Serves as a liaison between department’s analytical needs and technical data storage systems and files
Applies knowledge of database structures to ensure optimal logical model and effective/efficient mapping to physical structure
Bachelor’s Degree Computer Science/Technology, Business Administration, Mathematics, Statistics, or related field, required
Minimum of four (4) years experience working with databases, reporting applications and/or business intelligence applications, required
Experience with database tools (SQL, MS SQL Server), required
Advanced experience with Microsoft Office Excel, preferred
Reporting and analysis skills, preferred

VP Medical Economics Resume Examples & Samples

Lead a highly matrixed team to apply the medical economics / “creating customer value” process / discipline to deliver cost saving value to the market segments
Create business unit strategy in partnership with P/L owner
Establish and ensure medical cost category baseline performance and targets for the segment(s)
Ensure the cadence and depth of analysis necessary to understand changes in medical cost performance
Ensure timely and appropriate solution development to meet targets and to address newly observed medical cost concerns
Champion the implementation of specific initiatives as necessary
Within the context of the company’s total medical cost control needs, identify, manage and prioritize the portfolio of solutions/initiatives that will have the biggest impact on the segment(s)
Ensure that results are being measured and realized
Partner with Market Segment Strategy, Actuary and Finance to ensure that appropriate results are targeted, obtained and appropriately incorporated into pricing policy, forecast/planning processes, etc
Partner with Health Plan Finance, Medical Economics and Actuary to establish appropriate medical cost category targets for each function that will deliver necessary results to the market segment(s)
Ensure targeted performance is appropriately contemplated in current/future year projections and pricing models as well as monitored in the emerging financial results
Leverage the Medical Economics / Creating Customer Value governance processes to escalate and resolve issues
Regularly interact with senior Market Segment and Finance leadership to set and adjust targets and to resolve issues
Oversee the initiative management of select initiatives that have significant impact on the market segments(s)
Apply limited project management resources to manage those initiatives that deliver significant value to the segment(s), have no natural functional owner or otherwise need oversight
Work with Market Segment and Finance Leadership to ensure appropriate guidelines are followed when assigning initiative accountability
Shape the cross-functional process
Serve as the example for how the medical cost management discipline may be applied to the market segment to deliver specific results
Work with Medical Economics, Finance, other market segments, critical delivery functions to shape and adapt the processes, discipline, organization, governance or other
Lead in a matrixed work environment
Help drive a culture change from “reporting the past” to “creating the solutions for future.”
Collaborate with other market segment leaders, Finance and functional leaders. This will require strong communication skills (verbal and executive quality presentations)

Director of Medical Economics Resume Examples & Samples

Work with departmental staff to identify requirements for reporting and / or business intelligence tools
Identify necessary data, data sources and methodologies
Collect, organize, integrate, analyze and interpret data
Leverage advanced statistical analysis methods to create insightful recommendations and conclusions that you effectively communicate to your stakeholders
Identify and address expected and unforeseen data complexities to mitigate their impact on the analytic outcome and associated business decisions. Clearly communicate data issues to the recipients and work to improve data quality where possible within the analytical models you create. Feed data quality issues back to IT or identified data stewards to assist in our quest for high quality data
Develop and present reports, analyses and findings to senior management and others as scheduled or requested

Medical Economics Specialist Resume Examples & Samples

Leadership ability to analyze results working with multiple matrix partners across regions
Key player in achieving medical cost plans and earnings plans
Communication and influencing to ensure goals and targets are met. Will be responsible for initiating necessary escalation of risks and opportunities
Drives change initiatives to address future oriented business needs. Act as catalyst through multiple layers to spark enthusiasm, collaboration and results
This is an individual contributor position that works independently with only general direction
Enhance CGHB’s medical spend analysis and reporting capability to drive incremental value and in support of value add decision making; partner with finance
Manage the provision of data and analytics as needed to support cost containment initiatives, opportunity identification, and overall ROI assessment of initiatives for CGHB global spend (globally)
Lead cost containment projects to deliver stated savings. Ensure communications are timely and delivered to appropriate audiences on any developments resulting in risks and/or opportunities to the plan
Partner with global clinical leadership to define valid and reliable key performance indicators that accurately reflect outcomes and impact on matrix partners
Lead data consolidation activities to support global clinical reporting and analytics (Monthly Operational Reporting, Clinical Dashboards, Cost Containment/Savings Reporting) using multiple Business Intelligence reporting tools (for example: Cognos, Business Objects and Qlikview)
Prepare and present key strategic and tactical clinical analytics using Business Intelligence reporting tools to both managerial and front line partners to drive improvements in customer experience and healthcare costs
Present data that provides insights into key improvement opportunities, savings opportunities and case management opportunities
Develop insight into member and provider performance and the variables affecting performance
Partner with cost containment team to drive steerage, discounts, proactive and effective case management and additional savings opportunities
Be able to gather data from multiple sources using multiple technologies (SQL, Cognos, QlikView, Excel, Access, etc.) and consolidate into global dashboards and reports ready to be presented to senior leaders
Attention to detail to uncover data gaps and inconsistencies. Ability to deliver dashboards and reporting under tight deadlines
Bachelor’s degree in Mathematics, Biostatistics, Statistics, MIS or Finance is highly preferred
4+ years’ experience in business reporting and analytical roles required
2+ years of experience in managed care, medical cost reporting and analytics for the health insurance industry required
Proficient knowledge of medical terminology, cost components, contracting methodologies
Demonstrated analytical capabilities related to clinical and financial process improvements
Ability to maximize technology expertise to deliver re-usable and scalable business process enhancements
Demonstrated proficiency using advanced Excel features and techniques. Microsoft Access and SQL preferred
Experience working with a variety of information systems and data files, including large and complex files: analyzing file structure, using and creating file layouts, transforming raw data into finished products
Experience in identifying and developing key performance indicators and management reporting
Accomplished ability to manage multiple timelines and priorities for self and team
Demonstrated excellent leadership ability
Very strong verbal and written communication skills are required
Strong analytical skills and excellent presentation skills required

Medical Economics Informatics Senior Specialist Resume Examples & Samples

Be a liason between Cigna and the group to provide analytical support at negotiation of new FFV contracts
Show providers value of our programs and how to succeed in partnership with Cigna
Work with contracting/MME to develop strategies to accelerate the signing of FFV contract
. Acts as catalyst through multiple layers to spark enthusiasm, collaboration and results

Medical Economics Analyst Resume Examples & Samples

Perform statistical population health utilization and management analytics as directed by their Manager
Assist analytics team with development of total cost of care targets for at-risk populations
Support development of complex analytical models targeting operational efficiency improvements and reductions of cost per case variances
Gather data from multiple sources and build complex data sets to enable accurate and robust quantitative analyses
Develop deep understanding of the findings and effectively communicate them to analytics management and senior leadership
BS in a quantitative/analytically challenging field and 1-2 years of experience in healthcare analytics is preferred. Experience working at a health insurance plan is preferred
Experience with cost management and population health analytics is preferred
Advanced MS Access, Excel, and SQL skills preferred
Experience with EPIC Clarity model is a plus
Intellectual curiosity about analytics and improving health care delivery
Ability to work in a fast-paced and dynamic environment, with a drive to deliver outstanding results
Ability to work cooperatively and collaboratively with staff at all levels across the organization
Self-motivated person with a positive, professional attitude and ability to work independently and on teams

Senior Medical Economics Analyst Resume Examples & Samples

Proficient in both data aggregation and managed care specific acumen to interpret data
Communicates actionable findings, provides recommendations as appropriate to senior/executive management
Acts as the primary analytical resource in the development and interpretation of key monthly cost
Utilizes metrics that support the reserve process
Strengthen managements understanding of key drivers of medical cost and developing various "impact" and "scenario" models to assess financial exposure based on changes to business and contractual methodologies
Serves as a lead resource for a team of Medical Cost Analysts
Provides ad hoc analytical support to other departments such as Contract Management, Medical Management, and Vendor Oversight
Develop various sensitivity analytics to assess financial exposure based on changes to business/contractual methodologies
Provide ad-hoc analytical support to other departments for work related to Contract Management, Medical Management, and Vendor Oversight and other related concerns as requested
Superior data-aggregation techniques
Knowledge of Federal and NY State Medicaid reimbursement methodologies
Five years of financial healthcare analytical experience in a managed care setting, required
Proficiency in Microsoft Office; Outlook; SQL/SAS
Must have strong analytical and problem solving skills
BA/BS - Bachelors Degree in a related field, required
MA/MS – Masters Degree or equivalent preferred

Medical Economics Informatics Specialist Resume Examples & Samples

Support completion of new business proposals (e.g. RFPs) by providing value based financial analysis, metrics, and insights
Assist in analysis, creation, and maintenance of value based scorecards and reports delivered to various leaders and business partners
Develop meaningful relationships with business partners by delivering quantitative and qualitative data and insights for Cigna’s value based initiatives
Develop and improve reporting processes and documentation for quarterly reports, RFP requests, etc
Update scorecards/reports quarterly with latest historical and forecast data and share with matrix partners
Bachelor’s Degree strongly preferred
Minimum of 3 years of Financial experience strongly preferred
Minimum of 2 years of healthcare experience strongly preferred
Proven skill in understanding of individual market dynamics (healthcare providers, employers, and competitors, skill/experience in quality/payment innovation programs, health plan performance, etc.) to set strategies/tactics to achieve both cost and quality objectives
Excellent communication and presentation skills -- able to effectively explain and apply complex concepts in meaningful ways to all levels of organization
Experience with data analysis in Excel strongly preferred
Strong understanding of financial concepts such as ROI and cost benefit analysis
SQL/SAS coding experience desired but not required

Medical Economics Analyst Resume Examples & Samples

Working with all relevant stakeholders, produce analytics across a variety of subject matters including medical and quality management, network management, contracting, and new business development
Produce and monitor monthly trends in cost and utilization and quality metrics to explain drivers of financial results and highlight areas of opportunity for implementation of data-driven solutions to favorably impact medical costs and quality improvement
Utilize BI tools in designing dashboards, scorecards, and reports to track key healthcare quality and efficiency metrics by Risk Unit, practice, physician and care management program. Communicate findings of performance trends and identification of areas of opportunity for performance improvement
Use BI tools and/or SQL coding skills to support advanced analytic drill downs
Leverage, promote and support the use of existing technology and BI solutions available to Physician and Hospital stakeholders to provide data that will inform decision making and drive performance
Minimum of 3 years experience working in a health care analytics role
Field of study in mathematics, economics, statistics or finance preferred
Understanding of SAS, SQL Access, EHR systems, and/or EHR data constructs preferred
Experience with healthcare services utilization/reimbursement concepts and/or experience designing visual analytics in a business intelligence (BI) platform such as Tableau, Microsoft BI tools, or Qlik preferred

Senior Medical Economics Analyst Resume Examples & Samples

Manage the development of state of the art reporting that allows CCI to effectively understand cost of care trend drivers (both retrospectively and prospectively) and implement a communication strategy that allows this information to be effectively distributed to all interested departments
Conducts and coordinates cross-functional analysis of health care data to identify trends, explain plan results, and discover opportunities for plan improvement. Communicates findings to senior management and the appropriate stake-holders particularly Medical Operations, Network Operations, Actuarial and Underwriting through a monthly meeting with the other appropriate stake-holders facilitated by the Medical Economics Analyst
Design, develop, and implement statistically valid tests for internal and external assumptions for healthcare cost savings. Design methods that take into account the justifiable causes for variation in medical costs (age, sex, illness, severity, etc,) and develop reports that summarize this information in a way that management can use to make actionable decisions. Contribute to planning by determining what information is necessary to make valid decisions, generating the necessary information, and analyzing the information and making recommendations
Works with Medical Operations, Network Operations, Sales & Marketing, Operations, Actuarial and Underwriting to determine appropriate information for corrective action management reports. Designs and develops reports required to thoroughly understand the cost of care opportunities including the top trend drivers so action plans can be developed to address
Prepares sophisticated financial analysis of proposed contracting initiatives, including user-friendly utilization and cost reports
Works cross-functionally to develop, refine, and implement the data warehouse reporting strategy designed to make reporting at CCI a strategic advantage
Supports the initiatives of Medical Operations, Operations and Network Operations by providing applicable data and guidance on measurement
Identifies deficiencies in data quality and works cross-functionally to resolve
Develop other Contract Analysis & Implementation team members on cost of care analysis/reporting so CCI can develop analyst(s) to perform this analysis/reporting in their current role(s) so they can identify cost of care opportunities
Requires Bachelors Degree in Actuarial Sciences, Decision & Information Sciences, Medical Informatics, Finance or related quantitative field and 7 to 10 years of experience in the design, development, and management of informational analysis tools
Previous work experience in cost of care and trend analysis required preferably within a managed care environment
Must have previous work experience in interpreting financial results and explaining variances from budget to actual
Must have experience, training, or coursework in analysis and assessment of medical claims and forecasting. In lieu of a Bachelors degree and 5 years of experience as stated, we will accept a Masters degree in one of the stated fields and 3 years of work experience, and will view one year of Ph.D. studies as equivalent to each year of required work experience as stated on a one to one basis
Knowledge of relational database principles including PCSAS, SQL and MS-Office products (particularly MS-Access) are required. Knowledge of Cognos Powerplay, Upfront and Application development principles preferred
Excellent quantitative and analytical skills
Knowledge of medical terminology and coding methodologies required. HCPC, CPT, RBRVS, Diagnosis (ICD-9), DRG's required. 8. Good oral and written communication skills with work experience in presenting analysis to key stakeholders to support strategic business decisions. 9. Good project management skills

Senior Medical Economics Analyst Resume Examples & Samples

Responsible for the development, coordination and delivery of medical economics models and studies that drive health services outcomes
Performs in depth analysis on medical and pharmaceutical expense trends, interprets leading indicators, and effectively communicates actionable items
Demonstrates strong communication with the customer to thoroughly understand the business problem, work through issues, and produce the desired finished product
Models hospital, physician and ancillary contracts in order to advise network contractors during rate negotiations, as well as provide monthly analysis of overall network performance
Identify potential areas for medical cost improvements and alternative pricing strategies
Displays a high level of critical thinking to address complex business problems
Creates actionable information and effectively communicates results that support findings to customers
Collaborates with internal and external partners to understand data needs and design analytic studies that provide actionable results
Supports Medical and Financial programs through monitoring and tracking of initiatives
Proactively identifies potential areas for medical cost improvements and alternative pricing strategies
Provides ad hoc reports upon request and distributes/presents to internal customers including senior leadership
Deliverables are generated and distributed timely, reflecting detailed and accurate information with actionable conclusions
Manages change to requirements through effective use of change control processes and tools
Creates and maintains high quality documents, and adheres to quality standards set by Management
Assists in enforcement of project deadlines, schedules, and methodologies

Medical Economics Analyst Resume Examples & Samples

Proficient in both data aggregation and managed care specific acumen to interpret data; communicate findings and provide recommendations as appropriate
Provide ad hoc analytical support to other departments such as Contract Management, Medical Management, and Vendor Oversight
Act as primary analytical resource in the development and interpretation of key cost and utilization metrics that support the monthly reserve process and strengthen management's understanding of key drivers of medical cost
Develop various sensitivity analytics to assess financial exposure based on changes to business and contractual methodologies
Act as a support resource for provider performance reporting and report development and interpretation to understand medical cost, utilization and corresponding trends
Provide ad-hoc analytical support to other departments such as Contract Management, Medical Management, and Vendor Oversight
Health administration, economics, or finance in managed healthcare experience preferred
Three to five years related experience required
BA/BS - Bachelors Degree or equivalent required
MA/MS - Masters Degree or equivalent preferred
Proficiency in Microsoft Office: Excel, Word, Access; Outlook; SQL, required

Medical Economics Analyst Resume Examples & Samples

Creatively solve problems to drive results through use of project management, technology, and processes
Consistently improve the department through positive attitude, attention to detail, and thorough documentation of deliverables
Work collaboratively with other team members and take instruction effectively
Bachelor’s Degree in Analytics, Biostatistics, Statistics, Mathematics, Business, Finance or equivalent training, or any combination of education and experience, which would provide an equivalent background
Strong Excel skills (nested functions, index/match, vlookup, pivots) with a self-driven perspective towards researching and understanding various financial and operational issues. Ability to understand the business model and provide insights to our customers (e.g., contracting, finance, network operations, market leadership)
Strong understanding of SQL to be able to pull data and generate insights from that data
Strong interpersonal skills that can be leveraged to deliver market focused presentations to our customers and provide interpretation of analysis performed
Understand how to calculate PMPM and Per K metrics from medical and pharmacy claims data
Familiarity with medical and pharmacy claims, ICD10, DRG, APC, HCPCS, CPT considered a plus

Medical Economics Informatics Specialist Resume Examples & Samples

Analyze trend impact for hospital and physician group contract negotiations
Provide ad-hoc analysis and deep dives into data as appropriate to support negotiations and other activities contributing to medical cost improvement opportunities
Summarize and communicate findings and recommendations to matrix partners (Medical Economics, Contracting, Competitive Intelligence, Medical Management, Pricing, Sales)
Identify opportunities for trend reduction and engage Contracting to build these into plan where appropriate
Work closely with Provider Contract Database Analyst to maintain accuracy of forecasting tools
Proficient with relational database applications: MS Access, MS Excel, SQL
Strong healthcare data experience preferred (claims utilization, provider contracts)
Must be able to interpret and discuss data with others

Medical Economics Analyst Resume Examples & Samples

Bachelors degree in relevant field required, Masters degree preferred
Minimum of three (3) years of Data Analysis, Reporting, Claims, Case Management, Utilization Management or Healtcare experience required
Demonstrated skills with statistical analysis tool such as SAS and at least one reporting application such as Crystal Reports, MS Excel, MS Access, SQL

Medical Economics Analyst Resume Examples & Samples

Responsible for running queries and providing required analysis in order to understand related drivers (such as medical cost and utilization), as well as providing insightful commentary and sensitivity modeling analysis
Compile and analyze cost and utilization information in order to analyze complex system, corporate, or industry performance indicators
Partner with IT as primary stakeholder in the ongoing validation and development of client's Enterprise Data Warehouse (EDW)
Track and analyze provider financial performance metrics such as Medical Loss Ratio (MLR) in order to recommend options and solutions for the organization to meet objectives
Responsible for assuring the accuracy and validity of both source data and results and interpreting results into recommendations
Collaborate with Finance and other departments, including clinical, to analyze financial value of vendor contracts
Ongoing system validation and review of all applicable Federal and State reimbursement methodologies
Interfacing with, gathering information from and making presentations to various levels of management
Perform ad hoc pricing sensitivity analysis and evaluation for Contract Management and other internal customers
Developing professional expertise; applies company policies and procedures to resolve a variety of issues
Works on problems of moderate scope where analysis of situation or data requires a review of a variety of factors. Exercises judgment within defined procedures and practices to determine appropriate action
Builds productive working relationships
Managed Healthcare experience; insurance operations, a plus
Strong computer skills with demonstrated proficiency in Microsoft Office applications
Detail oriented with strong analytical and organizational skills
Self-starter with the ability to work under minimal supervision
Ability to communicate complex quantitative analysis in a clear, precise, and actionable manner
Strong time management skillswith the ability to multitask concurrent priorities in an organized manner
Strong oral and written communication skills to effectively communicate with all levels of management
Data reporting experience with SAS or SQL, a plus