Medical Economics Analyst II

Job Summary:

The Medical Economics Analyst II is responsible for analyzing healthcare cost and utilization, identifying, quantifying, and modeling opportunities to improve performance and reduce medical costs, evaluating healthcare programs and interventions, and presenting actionable analytical findings and recommendations to management.

Essential Functions:

• Identify and quantify cost savings initiatives to reduce medical costs within the markets
• Build financial models to quantify impact of medical cost reduction initiatives
• Assess overall health plan performance and perform root-cause analysis by analyzing medical cost, utilization trends, risk adjustment dynamics, revenue impacts, utilization management, and identifying key drivers, outliers, and opportunities for optimization
• Combine strong technical skills in SQL and Excel/Power BI with critical thinking, business acumen, and the ability to refine and edit analyses for accuracy and clarity
• Extract, manipulate, and validate large healthcare claims and prior authorization datasets using SQL and Microsoft Excel/Power BI
• Develop tools to efficiently identify new opportunities for cost savings
• Partner with various departments within organization to discuss, develop, and solution medical cost reduction initiatives
• Define appropriate populations, comparison groups, measures, and analytic methodologies to evaluate healthcare programs and interventions
• Evaluate the efficiency and effectiveness of clinical programs, interventions, processes, and medical cost reduction initiatives
• Present analytical findings and recommendations
• Support the intake, prioritization and coordinated execution of ad-hoc analytics requests from departments across the organization
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree or equivalent years of relevant work experience is required
• Minimum of two (2) years of experience in healthcare analytics is required
• Managed care experience is strongly preferred

Competencies, Knowledge and Skills:

• Advanced knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM prior authorization data, care management data, and demographic data
• Knowledge of Medicaid, Medicare and other government sponsored healthcare programs is required
• Advanced Excel proficiency (pivot tables, lookups, financial modeling, data validation)
• Proficient SQL skills, including complex joins, aggregations, subqueries/CTEs, data validation, and working with large healthcare datasets
• Familiarity with generative AI tools and their application to healthcare analytics, including use for analytical problem-solving, code development, research, and workflow efficiency
• Ability to synthesize complex data into clear findings, conclusions, and actionable recommendations
• Demonstrated ability to independently investigate healthcare cost and utilization questions, identify key drivers, validate findings, and develop actionable conclusions
• Ability to balance competing priorities
• Demonstrated written and verbal communication skills

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$72,200.00 - $115,500.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

 

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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Brand=CareSource