Medical Economics Consultant

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Role Overview

The Medical Economics Consultant position reports to the Manager of Medical Economics and Business Processes within Actuarial Analytics. This position is primarily responsible for developing large reporting layers, reports, executive decks, and enhanced metrics for our Total Cost of Care (TCOC) revenue and expense review process.  

Work Arrangement

• This is a 100% Remote position but you must live in EST or CST time zones

Responsibilities

• Meeting the business on needs for actionability from insight by helping develop High-Value Opportunities (HVOs) that are in the millions of dollars in savings/revenue added & validating ongoing initiative savings methodology & accounting
• Consultants have technical backgrounds and will create tools and reports that draw on disparate datasets and follow departmental infrastructure and practices to generate a complete picture of our medical expense and revenue trends, primarily Medicaid by member cohort and claim category, through the use of industry-standard KPI
• Consultants are expected to work with operational matrix partners to understand business processes in place to ensure reporting relevancy and present findings to leadership clearly and concisely
• Technology competencies include Azure Databricks, MS SQL Server, MS Power BI, Excel Data Models, or equivalent technologies

Education and Experience

• Bachelor’s Degree in Actuarial Science, Economics, Computer Science, IT, IS, or a related field strongly preferred OR equivalent combination of education and work experience will be considered
• One to three (1 – 3) years of experience working in Medical Informatics, Medical Economics, or related analytical positions at Managed Care Organizations, vendors, or providers
• Strong knowledge of health informatics terminology & classification schemes, i.e., CPT codes, ICD-10 dx, common groupers like DRGs, CCS, etc
• Strong knowledge of industry-standard population health & quality KPIs, i.e., utilization per thousand, readmission rates, HEDIS metrics, PMPM, and Cost per Unit
• Understanding of enterprise approaches to either MS SQL Server & related RDBMS technologies or MS Azure & related cloud computing data lake solutions; Mastery of SQL
• Strong knowledge of the anatomy of healthcare claims and/or encounters
• Strong knowledge of Excel
• Experience in SQL
• Excellent communication skills
   

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k), Tuition reimbursement, and more.

Your career starts now. We’re looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.