Medical Economics Analyst

Presbyterian is seeking a Medical Economics Analyst

This position will play a consultative role in analyzing medical and pharmacy data from Fluent Healths clients/partners to:

1.) develop, interpret and communicate medical and pharmacy cost trends,

2.) identify opportunities in provider networking/contracting, clinical and other areas, and

3.) support benefit design and pricing to achieve medical cost improvement within the Commercial, Medicare and Medicaid product lines.

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Benefits: PRN/PT (working less than a .45 FTE) employee benefits available for this position such as medical, gym memberships and an employee wellness program.

• Bachelors degree in healthcare, accounting, finance or other quantitative/related fields. Master�s degree is preferred.
• 4 years healthcare industry experience, specifically medical economics / product performance analyzing
• Must have knowledge and working experience in most of:
• Claim Procedure Coding: CPT/HCPCS, ICD DCS+PCS, DRG
• Claim Provider Coding: Bill Type, POS, Provider Types
• Benchmarking
• Risk Share Arrangements: Capitation, Shared Risk/Savings/Penalty, Quality Bonuses
• Provider/Vendor Contracting Analysis
• Claim Pricing & Provider Reimbursement
• Program/Project Pricing & Savings Valuation
• IBNR
• Forecasting/Projection/Budget
• Pricing (eg., Commercial small group/large group/individual)
• Benefit Change Determination/Pricing
• Rate Filings: Exhibits, Templates, Support
• Risk Adjustment/Risk Models (HCC, HIX, Commercial Products)
• Effective writing and oral communication skills.
• Advanced skills in MS Excel, Access, PowerPoint, Oracle SQL, and Business Objects.
• Two or more SOA exams passed is preferred.
• Tableau, SAS Enterprise Guide, and VBA programming knowledge and experience is preferred.

• Work closely with Finance, Actuarial, Underwriting, clinical operations, provider network and provider contracting teams.
• Utilize Millimans HCG Grouper model to perform drill-down analysis and research to identify the key drivers of medical and pharmacy cost trends.
• Consult with provider network/contracting, clinical operations and others on opportunities to improve utilization initiatives and mitigate trends.
• Monthly IBNR development.
• Support on Medicare Advantage D-SNP pricing and monitor D-SNP performance monthly.
• Track, document and communicate analysis and research with Med Econ teams of clients/partners.
• Provide support in development of reports as needed.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $56.92/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.