Fallon Health Senior Medical Economics Analyst - Growing Medicaid/ACO Program! in Worcester, Massachusetts

Overview

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Brief Summary:

The Senior Medical Economics Analyst will partner with the Medical Economics Medicaid Consultant and Fallon Medicaid stakeholders as a subject matter expert in data and analysis, demonstrating an in-depth understanding of financial, clinical, and other business data. This position will extract, analyze and interpret Healthcare data to uncover trends and assist in managing and understanding Medicaid medical costs. The Senior Analyst demonstrates business intelligence, being able to apply analyses to both financial as well as clinical operations in a meaningful manner. 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 as it pertains to a specific line of business. This individual provides complex ad hoc analysis and reporting 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 analysis activities. This position provides data in support of Financial and Utilization analyses, as it relates to medical cost improvements and alternative pricing strategies.

Responsibilities

Analysis, Decision Support and Business Intelligence

  • Provide cost and utilization quantitative and qualitative analyses for the Medicaid line of business and ACO partners

  • Provide actionable analyses and reports that help monitor performance and drive decision making to reduce total medical expense

  • Perform medical cost and utilization predictive analytics

  • Perform data mining to discover clinical patterns and relationship, to present to Management or ACO partners

  • Provide advanced analytical support for clinical initiatives including development, evaluation and ROI analyses

  • Perform analyses of actual cost and utilization against line of business benchmarks or targets

Financial and Clinical Model Design and Support

  • Design and perform program evaluation for clinical activities

  • Present financial analysis to Management and ACO partners

Ad-Hoc Support

  • Provide support for ad-hoc requests that require clinical, financial, pharmacy and operational analysis and reporting

  • Prepare reports and supporting analysis for internal and external stakeholders focused on reducing costs and financial performance against target

  • Be a resource for other members of the department, as well as internal and external stakeholders

  • Be a subject matter expert, train and guide other team members within the department as well as others within the organization, in data understanding and analytical processes

Qualifications

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

  • Experience working with a Medicaid population or product preferred by not required.

Job ID 5175

# Positions 1

Category Finance