Analyst-Medical Economics

Summary

The Medical Health Economics Analyst conducts and interprets complex healthcare data analysis, including financial modeling and risk assessment. Supports contract negotiations and evaluates reimbursement structures through detailed analytics. Manages multiple projects, ensuring accuracy and timely completion while recommending improvements and presenting findings to stakeholders.

• Job
• Job Category:
  Finance and Accounting
• Work Type:
  Full Time
• Work Schedule:
  
  Days
• Department:
  Revenue Cycle
• Facility: BMHCC System Services
• Location:
  
  Memphis, TN

The Medical Health Economics Analyst conducts and interprets complex healthcare data analysis, including financial modeling and risk assessment. Supports contract negotiations and evaluates reimbursement structures through detailed analytics. Manages multiple projects, ensuring accuracy and timely completion while recommending improvements and presenting findings to stakeholders.

• Research and analyze managed care data from the various financial systems and interface tools.
• Perform analysis of complex and varied healthcare data including financial modeling and risk forecasting.
• Work to identify/implement improvements in quality control/timeliness of reporting.
• Extract, collect, analyze and interpret health utilization and financial data of various types.
• Interpret and analyze data from various sources using knowledge of healthcare managed care contracts and healthcare administrative claims data.
• Employ existing complex models and implement them on new projects and/or new contexts and design new solutions for data and analytic challenges the organization faces.
• Support the negotiations of capitated and other VBA agreements between physicians/hospitals and payers/networks through detailed data analytics.
• Develop financial models and inform VBA negotiation parameters and evaluate possible changes to key terms in existing value‑based agreements.
• Identify risk/exposure associated with various reimbursement structures.
• Produce prospective analyses for new ventures, products, and service offerings.
• Prepare and effectively present analytics or project results to key stakeholders for review and decision‑making.
• Evaluate and understand contract language as it relates to reimbursement methodologies for the full spectrum of application provider types.
• Apply detailed understanding of medical coding systems affecting the adjudication of claims to include ICD‑9/10 CPT, CPT, HCPCS II, DRG and revenue codes.
• Demonstrate proficiency with various reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge.
• Recommend contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators.
• Provide ad‑hoc reporting, management and intelligence related to large claimants, sequestration and healthcare exchange programs.
• Accumulate data in logical format, interpret results, make recommendations and influence outcomes.
• Prepare well‑organized project‑specific documentation that includes at a minimum analytic methods used, key decision points and caveats with sufficient detail to support comprehension and replication.
• Lead in the development and review of the annual Managed Care net revenue budgets to support the annual budget process.
• Evaluate actual contract performance against expectations; analyze data to distinguish patterns and recognize trends in contract performance.
• Demonstrate independent thinking and creativity in the development of contract models, standard reports and ad‑hoc analyses.
• Manage and complete multiple projects in a fast‑paced environment within time frames outlined in the department policies and as specified by leadership.
• Maintain a high degree of accuracy while using large amounts of data.

Participates in special projects and performs other duties as assigned.

• Generally requires 3 to 5 years of related experience.
• Bachelor's degree in Finance, Health Care Administration, Accounting, Health Informatics, or a related field is required.
• Master's Degree in a related field preferred.

At…