Medical Economist
Saint Alphonsus Health System

Employment Type:
Full time
Shift:
Day Shift

Description:
At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.

The Medical Economist II establishes and maintains a consultative partnership with business owners, stakeholders and leadership. Work assignments are complex and responsibility requires in depth knowledge of financial and clinical analyses and cost and utilization trends related to payers, employers, and health plan data as well as strong analytical, investigative, interpretive and evaluative skills and the ability to contribute to leading/supporting small projects or portions of projects is expected. Responsibilities include, but are not limited to, developing and utilizing databases and reporting tools to extract data, generate reports, perform advanced data analysis and draft system/process improvement recommendations. Assignments may require interfacing with, gathering information from and making presentations to various levels of management and internal and external executive leaders. Serves as a subject matter expert and resource by providing guidance and problem/issue resolution to internal colleagues on matters impacting projects and day-to-day assignments.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

• Bachelor's degree or an equivalent combination of relevant education and experience required.
  
• A degree in Accounting, Business, Finance, Computer Science, Health Informatics, Healthcare Administration, Public Health, IT, Statistics or Math preferred.
  
• Minimum of four (4) years of progressively responsible experience in managed care data, programming, advanced analytics and payer analytics reporting.
  
• Knowledge and experience gained from health plan, health system, the healthcare industry or a provider health network is preferred.
  
• Strong organizational skills, with the demonstrated ability to prioritize and manage multiple concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments.
  
• Excellent analytical, quantitative, evaluative and problem-solving skills.
  
• Skilled in Microsoft product suite and business intelligence applications, financial systems/software, and/or statistical analysis software, e.g., Microsoft Office (Excel, Access), SAS, Minitab, Matlab, VBA/SQL, Business Objects.
  
• Strong ability to translate business questions into data requirements and business intelligence.
  
• Knowledge of healthcare operations, clinical quality, revenue cycle, health information technology, and health insurance products and operations or the willingness to obtain such knowledge through continuing education, e.g. American Health Insurance Plans (AHIP), Healthcare Financial Management Association (HFMA).
  
• Strong knowledge of medical terminology and coding methodologies including HCPC, CPT, RBRVS, Diagnosis (ICD-10), DRG's.
  

ESSENTIAL FUNCTIONS:

• Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.
  
• Conducts impact analyses and modeling, assesses utilization trends, identifies risks, develops projections, determines opportunities and prepares written recommendations and summaries for management review and decision-making.
  
• Develops and implements plans to measure and report on health care delivery cost and utilization trends; collaborates with system experts in developing sound analysis and analytic methodologies including participation on analytic team(s).
  
• Builds strong relationships internally and collaborates effectively on cross functional teams to define project plans and goals; manages and/or leads small projects or portions of projects with focused impact.
  
• Provides routine status reports and keeps management apprised ensuring project plans and deliverables are met.
  
• Plays a role in the development and maintenance of standard databases, data definitions, reporting tools, policies and procedures.
  
• Manages business intelligence vendor relationships and software solutions, in some instances acting as System Administrator and/or subject matter expert (SME).
  
• Works with business owners to develop and administer project work plans and timelines for timely delivery of business intelligence deliverables.
  
• Coordinates/conducts processes and audits to ensure accurate reporting solutions that are consistent with defined business needs.
  
• Utilizes claim valuation application, integrated financial systems, relational databases, business intelligence and desktop analytical reporting tools to access and manipulate data and develop detailed standard and ad-hoc reports and summaries that support department projects and initiatives.
  
• Utilizes applied research, statistical and financial analysis. Applies knowledge of relational database principles and coding, e.g. SQL, Business Objects. Applies knowledge of performance improvement and/or LEAN methodologies. Creates/maintains business intelligence methods, databases, dashboards, tools or systems.
  
• Creates/maintains documentation of knowledge assets, e.g. business rules, technical specifications (data mapping, data flows, dashboard content, data dictionaries).
  
• Collaborates with other teams, including SAHS Business Intelligence, to create necessary data extracts or databases for the purpose of performing specific clinical analyses and achieving organizational goals. Ability to manage/lead large projects or portions of projects.
  
• Ability to operate in a highly autonomous self-directed manner under frequently changing structures, requirements and priorities. Ability to respect confidential and sensitive information, understanding and honoring lines of accountability and communication is essential.
  
• Remains current on best practices and laws/regulations relative to areas of responsibility, e.g. familiarity with regulatory policies and requirements, HIPAA, Trinity Health Integrity and Compliance Program and Code of Conduct, The Joint Commission.
  
• Performs other duties as needed and assigned, including advanced ad hoc analytics such as modeling of contract and benefit scenarios. Utilizes statistical applications as necessary.
  

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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