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Medical Economics Sr Analyst
JOB MISSION SUMMARY
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.
RESPONSIBILITIES/REQUIRED SKILLS/EXPERIENCE
Job Responsibilities:
As a member of the North Central Compensation Development team, you will have a key role in analyzing and financial modeling of provider reimbursements. Responsibilities include:
Comparison intent of reimbursement v. actual reimbursement to assist in contract audit and identify opportunities for process improvement.
Develop and maintain monthly financial reporting for claims and capitation payments, including monthly variance analysis.
Financial analysis of physician reimbursement proposals
Assist with Primary and Specialty Capitation payment operations.
Research issues related to claim system payment and data warehouse interpretation of claims data
Prepare and communicate data and recommendations to Network Negotiators
Understand, express and develop financial and operational ideas which meet company objectives.
Skill or Experience Requirements:
Candidate must posses a working knowledge of reimbursement methodologies such as RBRVS and other industry standard fee schedule pricing, experience developing pricing strategies a plus.
Proven analytical skills.
Technically advanced used or Excel and Access, with ability to work efficiently with large data sets.
Experience interpreting contract terms, terminology, and the validation of contractual objectives.
Strong communication and organization skills.
The ability to systematically analyze complex problems, draw relevant conclusions, and successfully communicate solutions effectively.
Proven ability to consistently meet deadlines and appropriately set priorities accordingly.
Contract negotiation and/or provider relations background a plus.
Degree in business, finance, healthcare administration or related field preferred or 2 to 3 years equivalent work experience in the healthcare industry. Knowledge in provider contracting, provider reimbursement, product and benefits design.
Ideal candidate would have 2-3 years experience in a hospital pricing department.
Additional Job Information:
This position has the option to be a part time work from home.
In Medical Economics, we're committed to accurately predicting and controlling medical costs while reducing financial risk.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
