Medical Economics Analyst III
HealthNow New York Inc. - Buffalo, NY

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Position Summary:
Under the direction of the Medical Economics Unit, the incumbent is responsible for supporting the Healthcare Services department by leading projects and developing processes needed for day to day business activities. In addition, the incumbent is responsible for designing and maintaining statistical models and complex reports to extract accurate information needed for making data based business decisions, developing medical policy, identifying and reducing medical cost trends, and improving quality of care. The incumbent is expected to work closely with other departments and units on some projects and join focus groups such the Trend Team or the PIP core team. These projects such as provider settlement, mailing initiatives, or the Enterprise Data Warehouse project require good programming skills to be able to verify and signoff on validation of data extract and projects. This position is also responsible for creating report and project specifications, coding when applicable, and testing software applications from those or other specifications. In addition, this position is responsible for educating and assisting others with complex tasks, leading training and educational sessions and promoting professional communications, and sharing ideas with other teams and departments in an effective manner while learning about corporate operations and data resources to better service our customers. Under the direction the Medical Economics Unit, the incumbent is responsible for supporting the Medical Affairs department by developing projects and statistical models to extract accurate information needed for making data based business decisions and developing medical policy. The incumbent is also responsible for preparing complex reports and studies for a variety of uses including predictive modeling, cost trend analysis, quality improvement, measuring performance of case and disease management programs and analysis of health care plan information. The incumbent is expected to work closely with other departments and join focus groups such the Trend team or the MEDai Work Group. This position is also responsible for educating and assisting others with complex tasks, leading training and educational sessions and promoting professional communications, sharing ideas with other teams and departments in an effective manner while learning about corporate operations and data resources to better service our customers.

Primary Job Duties:
Oversees and organizes projects to aggregate and report findings, and to assist in obtaining solutions to problems

Works collaboratively and efficiently within the market and among divisions to facilitate corporate initiatives

Works collaboratively with the Business Intelligence Department to create a suite of reports using Cognos and EDW data

Works collaboratively with PIP core team and the HEDIS team to support business and technical requirements for the Provider Incentive Program and the HEDIS reporting

Devises and maintains operations to evaluate and educate providers and initiates programs and policies to incentivize and positively influence the quality and appropriateness of health care delivered

Validates data extractions and programs completed by BITS for a variety of preojects and initiatives

Creates and develops business models and solutions using a variety of tools, programs and software

Develops reports using business applications, such as Cognos, CRMS, MEDai, and ExpertRx

Acts as a consultant and trainer to department staff and internal customers in the areas related to data analysis

Develops ideas into business plans that Healthnow can inplement to reduce medical cost trends, and financial savings

Participates within medical community to provide positive relations, interacting with hospitals, physicians, other providers, vendors, and regulators, as appropriate

Develops ideas into business plans that HealthNow can inplement to reduce medical cost trends

Researches how to integrate medical and drug claims, lab data with demographic and HRA/HRP data, to develop models to predict members at risk of developing chronic conditions, such as diabetes, kidney failure and heart disease before they occur

Required Skills

Primary Skills/Knowledge:
Ability to work in a team environment

Demonstrated analytic abilities combined with capabilities for leading and completing projects with a minimum degree of supervision

Demonstrated project management skills are required as well as demonstrated effectiveness in interpersonal verbal and written communication skills

Extensive knowledge of statistical concepts and experience with advanced statistical modeling within healthcare

Extensive knowledge of PCs and related software applications, such as Word, PowerPoint, Excel, Access, SPSS, SAS, analytical tools and techniques

Demonstrated programming skills; knowledge of programming languages and tools

Extensive knowledge of relational databases and statistical analysis software

Extensive knowledge of health care insurance, managed care operations and medical management. Knowledge and understanding of benefit structures and provider arrangements is required

Ability to present complex statistical information to a wide range of audiences

Understanding of health care industry with a comprehensive knowledge of managed care concepts

Required Experience

Education:
BS - Bachelor of Science Degree in Mathematics, Statistics, Finance, Computer Science, Epidemiology, or related field required

Experience:
Minimum of 5 years experience in data analysis, statistical analysis and business modeling required

Working Conditions:
The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of the job.

Work involves walking, talking, hearing using hands to handle, feel or operate objects, tools, or controls, and reaching with hands and arms. Vision abilities required by this job include close vision and the ability to adjust focus

The employee may be required to push, pull, lift and/or carry up to 20 pounds

HealthNow New York Inc. - 3 years ago - save job - - block
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