Senior Medical Cost Analytics Advisor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Medical Cost Analytics Advisor based in the United States.

As a Senior Medical Cost Analytics Advisor, you will play a strategic role in advancing healthcare affordability through data-driven insights and financial analysis. You will support payment integrity initiatives by evaluating pre-payment and post-payment programs, clinical coding audits, and recovery opportunities to identify potential savings and improve performance. Leveraging advanced analytical tools and healthcare reimbursement expertise, you will translate complex data into actionable recommendations and compelling business cases for senior leadership.

You will collaborate with cross-functional teams spanning Finance, Claims, Clinical Operations, Compliance, Network, and external vendors to drive enterprise-wide improvements. You will also contribute to the modernization of reporting and analytics through automation and emerging AI-enabled technologies. This fully remote opportunity offers the chance to influence healthcare cost management and improve the efficiency of complex payment processes.

• Drive medical cost analytics:
  Identify trends, emerging risks, and cost-saving opportunities across payment integrity and cost containment programs to support broader healthcare affordability objectives.
• Translate data into strategic insights:
  Interpret complex analytical findings and communicate clear, actionable recommendations to technical teams, operational stakeholders, and senior executives.
• Develop financial assessments:
  Own financial impact analyses and business cases for strategic initiatives, including forecasting, variance analysis, financial modeling, and recommendations to improve program performance.
• Monitor program effectiveness:
  Evaluate pre-payment and post-payment editing programs, clinical coding audits, and recovery initiatives through dashboards, performance scorecards, and executive reporting materials.
• Identify cost recovery opportunities:
  Analyze billing patterns, coding practices, reimbursement methodologies, and claims data to identify and quantify potential savings, inappropriate payments, waste, and abusive practices.
• Collaborate across departments:
  Partner with Finance, Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, Product, and other enterprise teams to align analytical insights with business decisions.
• Support vendor management:
  Conduct data-driven vendor evaluations and sourcing analyses, providing insights to support negotiations, pricing models, contractual arrangements, and performance guarantees.
• Improve reporting capabilities:
  Strengthen reporting processes, improve data quality, implement appropriate controls, and develop scalable analytical solutions that support informed decision-making.
• Modernize analytics processes:
  Promote automation and the effective use of AI-enabled tools and advanced analytical methods to improve efficiency, accuracy, and analytical capabilities.
• Support strategic planning:
  Use analytical findings and program performance insights to inform enterprise priorities, identify improvement opportunities, and contribute to long-term affordability strategies.
• Ensure compliance and accuracy:
  Work within regulated healthcare environments, maintaining appropriate analytical controls and supporting audit, claims, and reimbursement-related requirements.
• Drive continuous improvement:
  Identify opportunities to enhance analytical methodologies, streamline workflows, and improve the overall effectiveness of payment integrity programs.

• Bachelor's degree in a quantitative…