Analyst, Health Economics

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Job Summary

The Health Economics Analyst identifies and provides data-driven insights and analytical support to financial and operational leaders. Success depends on using data and analytical expertise to generate business intelligence that highlights risks requiring mitigation and opportunities worth pursuing. This role functions as the main medical cost analytics advisor to Finance, Clinical, Operations, and Shared Services leadership, offering strategic, data-informed recommendations to positively impact the outcomes of our value-based care model.

Essential Duties & Responsibilities

• Analyze and interpret enrollment, revenue, and claims (utilization and unit cost) data to identify and solve business problems and continuously improve data-driven strategies and processes to improve financial results.
• Partners with finance, clinical, and operations leaders to create benchmarks to monitor medical cost trends and variances. Assists in the design and evaluation of company KPIs.
• Prepares and analyze medical cost and leading indicator data to develop presentations for executive management. Interpret results and articulate actionable recommendations that maximize profitability and ensure financial targets are achieved.
• Tracks performance of medical cost Key Performance Indicators (KPIs).
• Leverages data analytics and modeling to test, validate and track return of investment of existing and proposed medical cost strategies and initiatives.
• Works with Analytics and IT teams to validate data, enhance medical cost reports and tools, and help design new products for enterprise consumption.
• Builds strong and trusting relationships with leaders to support problem resolution and ensure overall awareness of medical cost issues and challenges.
• Supports finance in the development of medical cost targets, key metrics, and projections.
• Analyzes emerging medical cost results and forecast the impact of those results on future periods (including identification and execution of actions to improve those results).
• Prepares ad-hoc analysis of claims and medical cost/utilization KPIs for executive leadership.
• Performs other duties as assigned and modified at manager’s discretion.

Supervisory Responsibilities

• No supervisory responsibilities.

Education & Experience

• Bachelor’s degree: experience may substitute for education on a year-for-year basis above the minimum experience required
• Bachelor’s degree in Finance, Data Analytics or Economics and/or MBA preferred
• Minimum of two (2) years of related experience
• Experience in a Medicare Advantage, Hospital Systems and/or risk-based healthcare organization, preferred

Education Requirements

Education Level

Discipline

Required

Bachelor’s degree

Finance, Data Analytics or Economics

Knowledge, Skills & Proficiencies

• Strong analytical, problem-solving, critical-thinking, communication, and relationship skills
• Effective organization skills with the ability to work in a very fast-paced, team-oriented environment with minimal supervision
• Ability to interpret the needs of the organization and communicate actionable insights through analytics
• Ability to develop presentations to drive action/impact
• Ability to model financial concepts of ROI, IRR, etc.
• Strong financial acumen, problem-solving and analytical skills with keen attention to detail and accuracy
• Ability to analyze multiple data sources to develop deep understanding of market dynamics, identify and prioritize opportunities, and spot trends
• Extensive knowledge of healthcare/medical economics data such as hospital/physician /ASC claims, utilization data, and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APCs
• Excellent communication skills across verbal, written, and presentation applications (Microsoft Word, PowerPoint, Excel, etc)
• Experience with SQL required, Power BI preferred
• Spoken and written fluency in English
• This job requires use and exercise of independent judgment

Physical Requirements

This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Conditions

Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing. 

Travel Requirements

Amount of Expected Travel

Details

Yes

0-25%

Flexibility to travel to clinical sites as needed

Tools & Equipment Used

Computer and peripherals, standard and customized software applications and tools, and usual office equipment.

Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

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