Senior Medical Economics Data Analyst

Senior Medical Economics Data Analyst

Enlace Health delivers the only end-to-end solution that solves the infrastructure challenges driving today’s unsustainable healthcare system. Connecting payers, providers, and patients, Enlace™ empowers any type of healthcare delivery model, from facilitating retrospective programs to enabling risk for prospective programs. Combining executive-level healthcare DNA with an extensible technology platform, Enlace is the bridge from chaotic healthcare to the healthcare world when Triple Aim optimization is truly realized.

At Enlace Health, our people are our greatest asset. Our culture is founded upon integrity, hard work, and the relentless pursuit to make a difference. We think creatively, we like a challenge and draw inspiration from each other. The Senior Medical Economics Data Analyst is a key member of our retrospective and prospective program design, network analysis, and provider enablement. You will map out and construct detailed analyses, confront challenging and unfamiliar subjects, and interface with stakeholders across all departments and lines of business.

Success Measures:

• In 3 months:
• Understand the data within our Product Suite and the market value of our applications.
• Conduct ad hoc analysis on our data to identify opportunities or troubleshoot issues.
• Utilize database queries (P-SQL) to explore our data, our grouper models and our service categories.
• Identify, monitor and analyze principle health care cost drivers, by market segment, facility or provider, including utilization and referral patterns including reimburse rates (with factors such as allowed vs paid).
• Explain the logic within our grouper methodologies to a non-technical, non-healthcare person.
• In 6 months:
• Forecast results for quality, contract risk, financial opportunities and general Value-based Care (VBC) metrics.
• Lead analysis on comparison of different grouper methodologies (e.g., PACES, Prometheus, BPCI, etc.).
• Provide guidance on encounter-based vs person-based vs episode-based analytics in relation to our products.
• Analyze claims, membership and prior authorization data to identify early signs of trends or other issues related to medical care cost.
• Work with engineering to build quality checks, new analytics metrics and design value-add user reports.
• In 12 months:
• Utilize industry standards (such as HCC, RAF, CDPS) to overlay new forecast models onto our bundle/grouper models.
• Interpret client contract language to surface clear understanding or business rules, opportunities, short and long-term goals and critical reporting requirements.
• Coordinate program implementation with our Network Services and Provider Enablement teams to establish controls and metrics to validate and assure client goal success.

Responsibilities:

• Value new medical cost initiatives, applying financial modeling expertise and using independent judgment to determine the best methods and approaches to calculate accurate estimates of program savings.
• Conduct comprehensive analysis of healthcare data, claims, and financial reports to identify trends, patterns, and opportunities for improvement.
• Develop and implement advanced statistical models to assess healthcare costs, utilization, and performance metrics.
• Collaborate with internal and external partners to create accurate and insightful reports and enable critical decision making.
• Provide analytical support for strategic initiatives, such as contract negotiations, provider network optimization, and total cost of care management.
• Evaluate the financial impact of proposed changes and initiatives, recommending data-driven strategies to optimize outcomes.
• Coordinate program implementation with initiative owners and establish controls to validate that changes have occurred.
• Thoroughly vet and perform due diligence on potential value-based arrangements to assess financial impact, ensure operational feasibility, and identify impact on existing programs.
• Identify favorable and unfavorable performance trends within medical cost initiatives, communicate trends to leadership, and recommend changes to initiative owners to improve performance.
• Perform complex return on investment analyses for vendors to determine if their financial and clinical performance is achieving desired results.
• Keep abreast of Commercial, Medicaid and Medicare reforms and their impact on our clients.

 

Position Requirements:

• Bachelor’s degree with a concentration in Finance, Accounting, Business, or Healthcare Administration, or equivalent work experience.
• Analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.).
• Work experience with SQL where you have created SQL queries, pulled large data sets, and performed data manipulations/analysis.
• Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing VLOOKUP and advanced functions/ formulas, creating, using, and interpreting pivot tables, filtering, and formatting.
• Experience using business intelligence (BI) tools to build complex reports.
• Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
• In-depth knowledge of Medicaid and/or Medicare programs or other healthcare plans.
• Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
• Deep knowledge of value-based care and/or population health management.
• Excellent written and verbal communication skills, including comfort interacting with C-suite.
• Ability to travel up to 10%.

Preferred Qualifications:

• Deep knowledge of grouper methodologies across encounter, person and episode-based analytics.
• Start-up experience and aptitude.
• Experience collaborating effectively with a hybrid and/or fully remote team.
• Strong project management experience and ability to handle multiple projects in a fast-paced environment.
• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
• Experience using Tableau.

 

Position Perks:

Enlace Health offers competitive benefits and perks to all our employees! Our comprehensive benefits package is one of the many ways we show our employees how valued they are. All full-time employees are eligible for the following:

• FREE medical, dental, and vision insurance for employees on select plans
• $1740 annual contribution into qualifying HSAs
• UNLIMITED time off
• Matching 401(k) plan
• Mac laptop and accessories
• Company-paid short-term and long-term disability
• Company-paid life insurance
• Employee Assistance Program
• Annual professional development stipend

All employees are required to maintain confidentiality as related to patient information. Employees are required to follow the acceptable use policy while using any information systems owned or controlled by Enlace. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense. Security roles and responsibilities include:

• Implementing and acting in accordance with the organization’s information security policies
• Protecting assets from unauthorized access, disclosure, modification, destruction, or interference
• Executing particular security processes or activities
• Ensuring responsibility is assigned to the individual for actions taken
• Reporting security events or potential events or other security risks to the organization

The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. The requirements listed above are representative of the minimum knowledge, skill, and/or ability required. To perform this job successfully, an individual must be able to satisfactorily perform the essential functions of the job according to specific company requirements. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions. Qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, disability, or marital status.