Onsite is preferred, hybrid or remote work option is available. Candidates residing in the following states can be considered for remote work: Alabama, Florida, Georgia, Arkansas, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, West Virginia, and Virginia.
The Senior Medical Economist Analyst works closely with the Strategic Payment Relationships leadership to capture, integrate, transform, interpret and present healthcare data, in support of the best possible decision making and outcomes on a variety of strategic initiatives. They will lead payer analytics, payment modeling and reporting, in support of successful contract negotiations and payer performance monitoring. Serves as a primary resource for the VP of Strategic Payment Relationships and Director of Contracting for payer performance analytics. Assists Medical Economics Director with routine and ad-hoc dashboards, reporting and analytics in support of organization's financial operations and service line teams. Serves as a reimbursement methodology subject matter expert for the Medical Economics team.
Leads modeling of commercial and government payment methodologies for all types of healthcare services: hospital, physician, ambulatory, home health, hospice, etc. Transforms data into analytical insights, to inform decisions for the Contracting team and Carilion executive stakeholders. Effectively communicates analysis to be consumed by department and executive leadership. Demonstrates expert knowledge of both commercial and governmental payers for modeling and analyzing contract proposals with a variety of reimbursement methodologies: case rates, DRG, fee schedules, stoploss and other contract terms. Leverages hospital (FinThrive) and physician (Experian MPV) claim modeling systems for enhanced payer contract analytics. Continuously learns and adapts to a constantly changing reimbursement environment. Completes extensive and complex financial and operational analyses, modeling of managed care contracts and proposals, analyze fee schedules, and determine contract performance and compliance. Extracts, analyzes, and synthesizes data from various sources to identify risks and opportunities. What We Require:
Education: Bachelor’s degree in finance, accounting or business-related field required. Four years of relevant experience may be considered in lieu of Bachelor’s degree.
Experience: ·3+ years of related experience with Bachelor’s. Extensive knowledge of commercial and government reimbursement. Advanced knowledge of the revenue cycle. Advanced analytical and problem-solving skills. Advanced Microsoft Excel skills. Clear, effective communication skills. Detail orientation
Licensure, certification, and/or registration: · Lean Six Sigma (recommended) · Certified Associate in Project Management (CAPM) (recommended)
Other Minimum Qualifications:
This is Carilion Clinic ...
An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.
Requisition Number: 149722
Employment Status: Full time
Location: CASB - Carilion Administrative Services Building
Shift: Day
Shift Details: FT Day
Recruiter: MARK A MISKOVIC
Recruiter Phone:
Recruiter Email: mamiskovic@carilionclinic.org
For more information, contact the HR Service Center at 1-800-599-2537.
Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
Carilion Clinic is a drug-free workplace.