medical economics analyst

Presbyterian Healthcare Services

<div>Location Address:
9521 San Mateo NE Albuquerque, NM 87113-2237

Compensation Pay Range:
Minimum Offer $77,563.20 Maximum Offer $118,393.60 Now Hiring: Medical Economics Analyst
Summary:
Build your Career. Make a Difference. Presbyterian is hiring a skilled Medical Economics Analyst to join our team. Type of Opportunity: Full time Job Exempt: Yes Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Days (United States of America)

Responsibilities:
Presbyterian is seeking a Medical Economics Analyst
This position will play a consultative role in analyzing medical data, specializing in reporting savings for payment integrity related processes, including pre-payment claim edits, pricing adjustments, and other cost-reduction initiatives. Reconciliation to vendor invoicing to ensure appropriate fee payments will also be integral to the role, along with creating and modifying SAS-based solutions for these processes.
Will be required to perform financial impact quantifications and projections that will impact budget setting. Expected to investigate, suggest, and develop different modelling avenues and varying data sets. Will own quantification process including reporting various perspectives of impact within in integrated delivery system.
Some key responsibilities include:<ul><li>
Work closely with Finance, Actuarial, Underwriting, clinical operations, provider network and provider contracting teams.</li><li>
Utilize Millimans HCG Grouper model to perform drill-down analysis and research to identify the key drivers of medical and pharmacy cost trends.</li><li>
Consult with provider network/contracting, clinical operations and others on opportunities to improve utilization initiatives and mitigate trends.</li><li>
Monthly IBNR development.</li><li>
Support on Medicare Advantage D-SNP pricing and monitor D-SNP performance monthly.</li><li>
Track, document and communicate analysis and research with Med Econ teams of clients/partners.</li><li>
Provide support in development of reports as needed.</li></ul>
Qualifications:<ul><li>
Bachelors degree in healthcare, accounting, finance or other quantitative/related fields. Masters degree is preferred.</li><li>
Four years healthcare industry experience, specifically medical economics / product performance analyzing</li><li>
Claim Procedure Coding: CPT/HCPCS, ICD DCS+PCS, DRG</li><li>
Claim Provider Coding: Bill Type, POS, Provider Types</li><li>
Benchmarking</li><li>
Risk Share Arrangements: Capitation, Shared Risk/Savings/Penalty, Quality Bonuses</li><li>
Provider/Vendor Contracting Analysis</li><li>
Claim Pricing &amp; Provider Reimbursement</li><li>
Program/Project Pricing &amp; Savings Valuation</li><li>
IBNR</li><li>
Forecasting/Projection/Budget</li><li>
Pricing (eg., Commercial small group/large group/individual)</li><li>
Benefit Change Determination/Pricing</li><li>
Rate Filings: Exhibits, Templates, Support</li><li>
Risk Adjustment/Risk Models (HCC, HIX, Commercial Products)</li><li>
Effective writing and oral communication skills.</li><li>
Advanced skills in MS Excel, Access, PowerPoint, Oracle SQL, and Business Objects.</li><li>
Two or more SOA exams passed is preferred.</li><li>
Tableau, SAS Enterprise Guide, and VBA programming knowledge and experience is preferred.</li></ul>
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits. 
Wellness 
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more. 
Why work at Presbyterian? 
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. 
About Presbyterian Healthcare Services 
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.<h1 class="jobSectionHeader">
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services</h1></div>

Medical Economics Analyst

Sanford Health

Careers With Purpose 
 
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. 
 
Facility: Remote WI
 
Location: Remote, WI
 
Address:
 
Shift: 8 Hours - Day Shifts
 
Job Schedule: Full time
 
Weekly Hours: 40.00
 
Salary Range: $29.00 - $46.50 
 
Department Details 
 
The Medical Health Economics Analyst uses data analysis to identify medical cost trends, evaluate financial performance, and provide actionable insights to support strategic business decisions. This role is vital for cost containment and improving plan performance. 
 
Job Summary 
 
The Medical Health Economics Analyst uses data analysis to identify medical cost trends, evaluate financial performance, and provide actionable insights to support strategic business decisions. This role is vital for cost containment and improving plan performance. Analyze complex medical claims, pharmacy data, and other healthcare data sets to identify emerging cost and utilization trends, patterns, and outliers. Develop financial models to evaluate the financial impact of new clinical programs, new initiatives, and value-based agreements. Identify opportunities for medical cost reduction, quantify potential savings, and measure the return on investment (ROI) of implemented initiatives. Create clear, concise reports, dashboards, and presentations using data visualization tools to communicate complex findings and actionable insights to a variety of stakeholders, including senior management and clinical departments. Work closely with accounting, actuarial, underwriting, clinical, health services delivery and network management teams to provide analytical support for decision-making and strategic planning, such as informing payer negotiations and risk adjustment strategies. Ensure the accuracy and integrity of data used in analyses, and prepare well-organized project documentation including methodologies and key decision points. Respond to ad-hoc data analysis requests from various departments, providing timely intelligence related to specific business problems. 
 
Qualifications 
 
Bachelor&rsquo;s degree in Economics, Statistics, Finance, Public Health, Mathematics, Actuarial Science, Data Analytics or related quantitative discipline required. 
 
1-3 years of progressive analytical experience in a healthcare setting (health insurance, managed care, or health system) is required. 
 
Knowledge of STARs and Risk Adjustment preferred. 
 
Strong analytical, problem-solving, critical thinking, and communication skills are vital for success in this role. 
 
Proficiency in SQL for data extraction and manipulation is a must. 
 
Advanced Microsoft Excel skills, including pivot tables and complex formulas, are essential. 
 
Experience with data visualization tools like Tableau or Power BI is highly valued. Familiarity with statistical tools such as SAS, R, or Python is often a plus. 
 
Benefits 
 
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits . 
 
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org . 
 
Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment. 
 
Req Number: R-0256333
 
Job Function: Health Plan
 
Featured: No

Medical Economics Analyst, Health Plan

Progyny

<div>Thank you for considering Progyny!
Progyny [NASDAQ: PGNY] is a leading healthcare company and is reshaping family building by providing innovative fertility benefits to millions of people. We are hiring a Business Analyst to join the Medical Economics and Analytics team in New York City.
Our team is at the forefront of key strategic initiatives of the nation&rsquo;s leading fertility benefits management company. In this role, you&rsquo;ll advise on strategic initiatives by conducting data analysis, collaborating cross-functionally, and presenting to various internal stakeholders, including senior leadership. You will learn the nuances of fertility, dive into the complex world of healthcare analytics and contribute to meaningful changes in the way we support our members and clients.
What you'll do...<ul><li>
Analyze sales performance, pipeline health, conversion rates, and customer segments to identify growth and upsell opportunities</li><li>
Create dashboards and regular reporting to track project impact on KPIs; celebrate successes and identify &amp; address failures</li><li>
Identify opportunities for operational or strategic improvements and communicate recommendations to leadership</li><li>
Develop mastery in Excel, SQL and PowerBI to support analysis and operations of your stakeholder&rsquo;s key initiatives</li><li>
Drive cross-functional collaboration by creating developing project plans and managing stakeholders across teams including any of the following Sales, Client Success, Partnerships, Marketing, Finance and Data Engineering teams</li><li>
Support in the presentation of insights to key stakeholders (including VPs, Sales and Client Success Leaders, and C-suite)</li></ul>
About you...<ul><li>
1-3 years of relevant experience, preferably at a top-tier consulting firm or healthcare company</li><li>
Bachelor&rsquo;s degree required</li><li>
Enjoys analyzing large sets of data (30M+ rows)</li><li>
Proficiency in Excel required</li><li>
Proficiency in SQL required</li><li>
Prior experience with data visualization tools (e.g. Power BI, Cognos, Tableau, Looker) preferred</li><li>
Organized and methodical with strong attention to detail</li><li>
Demonstrated ability to be adaptive and inquisitive; natural problem solver</li><li>
Ability to work autonomously with minimal direction on multiple endeavors at once</li><li>
Driven to deliver results with the ability to establish rapport, earn trust, and effectively collaborate with others</li></ul>
Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.
About Progyny:
Progyny (Nasdaq: PGNY) is a global leader in women&rsquo;s health and family building solutions, trusted by the nation&rsquo;s leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians.
Our benefits solution empowers patients with concierge support, coaching, education, and digital tools; provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.
Our mission is to empower healthier, supported journeys through transformative fertility, family building and women&rsquo;s health benefits.
Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit www.progyny.com.
Our perks:
<ul><li>Family friendly benefits: Paid family and parental leave, preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund, and Parents&rsquo; Employee Affiliation Group</li><li>
Menopause and midlife care</li><li>
Health, dental, vision and life insurance options for employees and family</li><li>
Free in-person, virtual and text-based mental health and wellness support
</li><li>Paid time off, including vacation, sick leave, personal days and summer flex time</li><li>
Company equity</li><li>
Bonus program</li><li>
401(k) plan with company match</li><li>
Access to on-demand legal and financial advice</li><li>
Learning and development programs to help you grow professionally and a mentorship program</li><li>
Company social events to include annual volunteer day and donation matching</li><li>
Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office</li></ul>
In compliance with New York City's Wage Transparency Law, the annual salary [wage] range for NYC-based applicants is: $70,000 - $90,000. There are a variety of factors that go into determining a salary range, including but not limited to external market benchmark data, geographic location, and years of experience sought/required. Progyny offers a total compensation package comprised of base salary, cash bonus, and equity.
Progyny is proud to be an Equal Opportunity and Affirmative Action employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills and experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability, age, genetic information, marital status, pregnancy or related condition, status as a protected veteran, criminal history consistent with legal requirements or any other basis protected by law.
If you are an individual with a disability and need assistance or an accommodation during the recruiting process, please send an e-mail to apply@progyny.com.
#LI-BG1</div>

Business Analyst, Commercial Sales

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary 
As a Medical Economics Manager, you will develop and maintain recurring and ad hoc reports to support the needs of internal and external customers, including regulatory and compliance needs, as well as network support. An ability to comprehend complex report requirements, summarize available data to meet those requirements and maintain documentation will be key. The role will include access to the Enterprise Data Warehouse and the use of various tools and platforms including GCP and Python.
Key Responsibilities:<ul><li>
Collaborate with cross-functional teams to develop and maintain reports and resources required by internal and external constituencies.</li><li>
Review complex reporting requirements and apply the requirements to available data in the EDW and elsewhere.</li><li>
Review existing reports to look for opportunities to increase efficiency and improve accuracy.</li><li>
Utilize SQL and other available tools to create ad hoc reports as needed.</li><li>
Monitor deadlines to finish projects accurately and on time. Keep leadership and requesters apprised of risks.</li><li>
Work constructively with team members to achieve common goals.</li></ul> 
Required Qualifications:
<ul><li>5+ years of experience in healthcare or finance reporting.
</li><li>Proven proficiency in MS Office with advanced proficiency in Excel.</li><li>
Proven proficiency using SQL to query large relational databases.</li><li>
Proven analytical skills with experience using data to report cost and utilization patterns.</li></ul>
Preferred Qualifications:<ul><li>
5+ years of experience in an analytical role in the healthcare industry.</li><li>
Experience using BigQuery and other GCP tools.</li><li>
Experience using Python to move and analyze data.</li><li>
Experience reporting healthcare utilization, as well as an understanding of common formulas used in healthcare analytics.</li></ul> 
Education
BS/BA in Finance, Economics, Math, Healthcare Administration or another STEM field or equivalent relevant experience is required.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,300.00 - $145,860.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 04/20/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

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