Medical Health Economics Analyst, Full-Time, Days

Jackson Health System

Department: Jackson Memorial Hospital - Population Health

Address: 1611 NW 12th Ave, Miami, Florida, 33136

Shift details: Full-Time, Days

Why Jackson:

Jackson Health System is a nationally and internationally recognized academic medical system offering world-class care to any person who walks through our doors. For more than 100 years, Jackson has evolved into one of the world''s top medical providers for all levels of care, no matter if it''s for a routine patient visit or for a lifesaving procedure. With more than 2,000 licensed beds, we are also proud of our role as the primary teaching hospital for the University Of Miami Miller School Of Medicine.

Here, the best people come together to deliver Jackson''s mission for our diverse communities. Our employees are committed to providing the best CARE by demonstrating compassion, accountability, respect, and expertise in everything we do.

Summary

The Medical Health Economics Analyst conducts and interprets complex healthcare data analysis, including financial modeling and risk assessment. Supports contract negotiations and evaluates reimbursement structures through detailed analytics. Manages multiple projects, ensuring accuracy and timely completion while recommending improvements and presenting findings to stakeholders.

Responsibilities

• Research and analyzes managed care data from the various financial systems and interface tools.
• Performs analysis of complex and varied healthcare data including financial modeling and risk forecasting.
• Work to identify/implement improvements in quality control/timeliness of reporting.
• Extracts, collects, analyzes and interprets health utilization and financial data of various types.
• Interpret an analyze data from various sources using knowledge of healthcare managed care contracts and healthcare administrative claims data.
• Employs existing complex models and implements them on new projects and/or new contexts and she/he designs new solutions for data and analytic challenges the organization faces.
• Support the negotiations of capitated and other VBA agreements between physicians/hospitals and payers/networks through detailed data analytics.
• Develop financial models and inform VBA negotiations parameters and evaluate possible changes to key terms in existing value-based agreements.
• Identify risk/exposure associated with various reimbursement structures.
• Produce prospective analyses in new venture, products, and service offerings.
• Prepare and effectively present analytics or project results to key stakeholders for review and decision-making.
• Evaluate and understand contract language as it relates to reimbursement methodologies for the full spectrum of app provider types.
• Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II, DRG and revenue codes.
• Demonstrates proficiency with various reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge.
• Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators.
• Ad-hoc reporting, management and intelligence related to large claimants, sequestration and healthcare exchange programs.
• Accumulates data in logical format, interprets results, makes recommendations and influences outcomes.
• Prepares well-organized project-specific documentation, that includes at a minimum, analytic methods used, ley decision points and caveats with sufficient detail to support comprehension and replication.
• Leads in the development and review of the annual Managed care net revenue budgets to support the annual budget process.
• Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance.
• Demonstrates independent thinking and creativity in development of contract models, standard reports and ad hoc analyses.
• Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by leadership.
• Maintains a high degree of accuracy while using large amounts of data.
• Participates in special projects and performs other duties as assigned

Experience

Generally, requires 3 to 5 years of related experience.

Education

Bachelor''s degree in finance, Health Care Administration, Accounting, Mathematics, or Health and Informatics or related field required. Master''s Degree in a related field preferred.

Skill

Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment. Knowledge and skill in use of job appropriate technology and software applications.

Credentials

Valid license or certification is required as needed, based on the job or specialty.

Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.