Senior Medical Economics Analyst

Position Overview

We are seeking an experienced Sr. Medical Economics Analyst to join our value-based care (VBC) team in our Accountable Care Organization (ACO). This role requires a seasoned professional with 3-5 years of data analytics experience who can navigate the complex landscape of Medicare risk models, value-based care arrangements, and population health analytics. The ideal candidate will play a critical role in optimizing our organization's performance under CMS total cost of care models while ensuring sustainable financial outcomes.

Key Responsibilities

Risk Assessment & Medicare Analytics

• Develop and maintain sophisticated risk-adjusted provider group performance models using CMS-HCC methodology.
• Analyze VBC performance under various CMS and CMMI total cost-of-care models.
• Monitor and forecast financial performance across assigned patient populations.
• Conduct comprehensive claims analysis using CCLF (Claims and Claims Line Feed) and BCDA (Beneficiary Claims Data API) datasets, including simulating CMS-HCC risk adjustment.

Data Management & Analytics

• Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.
• Ensure data quality and integrity across all analytical processes.

Business Intelligence & Reporting

• Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights.
• Develop executive dashboards and performance metrics aligned with organizational strategic goals.
• Present findings and recommendations to leadership teams and clinical stakeholders.
• Support budget planning and financial forecasting processes.

Regulatory Compliance & Process Improvement

• Stay current with evolving CMS and CMMI program requirements and quality measures.
• Collaborate with revenue cycle and coding teams to optimize documentation and billing accuracy.

Required Qualifications

Education & Certification

• Bachelor's degree in Data Science, Statistics, Mathematics, Economics, Business Administration or related quantitative field

Experience Requirements

• 3-5 years of data analytics experience, preferably in healthcare or Medicare-focused environments
• Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models
• Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs
• Proven track record analyzing Medicare claims data, specifically CCLF and BCDA datasets
• In-depth knowledge of healthcare billing processes from both provider and CMS perspectives

Technical Proficiency

• Advanced proficiency in Microsoft Excel (pivot tables, complex formulas, VBA preferred)
• Strong SQL skills with ability to write complex queries and optimize database performance
• Experience with Microsoft Azure cloud platform and related analytics tools
• Proven ability to work with very large datasets (multi-million row files) and combine data from multiple sources
• Experience integrating EHR data with claims datasets for comprehensive population health analysis

Core Competencies

• Exceptional analytical and problem-solving capabilities
• Strong business acumen with the ability to translate technical findings into strategic recommendations
• Excellent written and verbal communication skills for both technical and non-technical audiences
• Proven team player with a collaborative approach to cross-functional projects
• Demonstrated capability to understand and respond to evolving business needs

Location: Fully Remote (with up to 10% travel)

This position requires the ability to work with sensitive healthcare information and maintain strict confidentiality in accordance with HIPAA and other applicable regulations.