Senior Medical Economics Analyst

About us:

Fallon Health is a company that cares. We prioritize our members-always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation's top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)- in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

We can only hire from the Following states for this position:

MA, CT, RI, NH, NY (not Burroughs)
• FL, GA, TX, NJ
• ME, VT

Brief summary of purpose:

The Medical Economics Senior Analyst will partner with the Manager, Medical Economics as a subject matter expert in data and analysis, demonstrating an in-depth understanding of financial, clinical, and other business data. The position works directly with operational leadership in the design and development of analytical capabilities, reports, and dashboards needed for short and long-term decision-making to achieve success in managing care. This individual provides complex ad hoc analysis and reporting as directed by management to include the evaluation of financial, operational, clinical and general business programs and processes. The Senior Analyst is responsible for data quality and data integrity as they relate to reporting and analytical activities.

Primary Job Responsibilities

Analysis, Decision Support and Business Intelligence - 45%

• Provide actionable analyses and reports that help monitor performance and drive decision making to reduce total medical expense and utilization
• Assist in designing initiatives to impact cost drivers, including measurement and monitoring of initiatives. Identify the cost drivers, quantify variances, formulate and propose strategies and communicate the outcomes to customer, business owners and senior management
• Evaluate the impact of current vs. proposed financial arrangements with providers; compare payment terms against Medicare and Medicaid reimbursement methodologies
• Perform cost and utilization trend analyses at the provider, PHO, employer or other group variation.
• Measure actual performance against benchmarks or targets
• Provide advanced analytical and reporting support to customers on various projects
• Leads or assists in process improvement and special projects

Regulatory & Clinical Model Design and Support - 30%

• Provide support for regulatory reporting; analyze specifications to develop accurate responses or summaries for timely submissions
• Provide analytical support for clinical initiatives including development, evaluation and ROI analyses
• Evaluate the effectiveness of clinical initiatives in improving patient outcomes and reducing health care costs

Ad-Hoc Support - 25%

• Provide support for ad-hoc (i.e. one time) requests that require clinical, financial, regulatory, pharmacy and operational analysis and reporting.
• Prepare reports and supporting analysis for internal and external customers focused on reducing costs and utilization and enhancing healthcare system efficiency.
• Act as a resource for other members of the department on business issues.
• As a subject matter expert, train and guide other associates in the department in data understanding and analytical processes.

Education

• Bachelor's degree in Business, Finance or Public Health

Experience

• Minimum of 5 years of financial or analytical experience in healthcare environment
• Experience with data analysis, interpretation and reporting of clinical and financial data
• Experience with Microsoft Excel, ACCESS, SSMS or SQL
• Ability to design, evaluate and interpret complex data sets
• Knowledge of managed care and health care claims
• Excellent oral and written communication skills

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $110,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate's experience, skills, and fit with the role's responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.