Value Based Care Healthcare Economics Analyst

Provide analysis related to Value Based Care (VBC) program cost of care and affordability. Review and manage VBC financial processes and activities, including BlueCard VBC Programs. Provide ideation and support for medical cost improvements in collaboration with key business partners (clinical, provider, strategy, finance, actuarial). Perform data extraction, create healthcare cost analysis, analytical model development, as well as production of various reports and tracking mechanisms to support medical cost containment solutions. Oversee and support VBC financial performance.

REQUIRED QUALIFICATIONS

Required Work Experience

• 2 year of experience in data analysis using analytic tools and processes (Level 1)
• 4 years of experience in data analysis using analytic tools and processes (Level 2)
• 6 years of experience working for a healthcare organization/heath insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 3)
• 8 years of experience working for a healthcare organization/heath insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 4)

Required Education

• Bachelor's Degree in mathematics, statistics, business, or related field of study (Applies to All Levels)

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 3 year of experience in data analysis working for a healthcare organization / health insurer (Level 1)

• 4 years of experience working for a healthcare organization / health insurer, including development of business analytics and financial impact analyses (Level 2)
• 7 years of experience working for a healthcare organization / health insurer, including development of business analytics and financial impact analyses (Levels 3, 4)

Preferred Education

• Masters Degree in mathematics, statistics, business, or related field of study. (Applies to All Levels)

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL job functions AND RESPONSIBILITIES

Level 1

• Managing and reviewing VBC financial settlements and performance (finance/cost and utilization)
  • Includes managing approval process and signatures, as well as tracking invoices and confirming receipt
• Reviewing trends and total cost of care for our VBCs
  • Including deep dives when we are settling and deep dives for utilization/cost management strategies to collaborate on with VBC performance team
• Updating ELT financial dashboards and distributing
• Support contract reviews and negotiations with additional analytics supports for benefit/ROI
• Provide accurate, timely and reliable delivery of data, metrics, reporting and analysis in support of multiple strategic goals and initiatives
• Develop processes, write programs and/or create databases using analytic tools to produce accurate and timely completion of analytic solutions
• Identify, analyze, interpret and validate healthcare data metrics, trends and patterns
• Develop and analyze business performance reports (e.g. for claims data, provider data, utilization data) and provide notations of performance deviations and anomalies.
• Model financial impact analyses for a variety of business initiatives
• Partner with peers to establish, evaluate, and continually improve measurement methodologies, while adhering to nationally accepted analytic and reporting standards
• Act as liaison to both internal business partners and external providers or vendors
• Create, modify, maintain, and enhance existing programming or business processes associated with specific responsibilities.
• Interpret, communicate, and present results to all levels of management in consistent and easy to understand formats to facilitate fact-based decision-making.
• Complete projects within preset timelines and report status to supervisor and project manager.
• Prepare written documentation on projects to provide a peer review trail and ensure continuity and integrity.
• Build and maintain close working relationships with internal stakeholders and key external client contacts (e.g. Providers/VBC Partners, Internal Clinicians, Vendors, BCBS Association, Blues Plans, Auditors).

Level 2

• Serve as an internal healthcare economics consultant to define business questions and transform data and analysis into meaningful and actionable information for a variety of business areas
• Perform complex analyses and interpret complex calculations to recommend actions and solutions
• Develop financial models needed to accomplish analytic goals
• Serve as subject matter expert for internal stakeholders
• Design and deliver self-service business intelligence tools to internal customers
• Make sound assumptions and fact-based recommendations and discuss with supervisor, manager, or project manager.
• Effectively communicate results and recommendations to internal and external customers.
• Provide self- and peer-review of job responsibilities
• Share knowledge of skills, projects, and business needs with peers and less-experienced analysts. Train new analysts.
• Report to a supervisor or manager who provides general supervisory instructions, manages projects and reviews results. Develops own work-plans, and discusses timelines, prioritization, and objectives with supervisor or manager.

Level 3

• Create/Ideate and research analyses and recommendations which help achieve corporate initiatives and goals
• Produce complex analytic solutions and consolidate complex analytics into easy to understand presentations focused on business implications
• Deliver business intelligence to Leadership by applying and demonstrating expertise in the areas of advanced analytics, forecasting, and data extrapolation.
• Communicate (both verbally and in writing) and interpret results, recommendations and abstract concepts to internal and external customers. Anticipate and address possible customer questions and concerns.
• Report to a supervisor or manager who provides minimal supervisory instructions, limited project management, and minimal or limited review of results beyond pre-release peer review.
• Train and mentor other analysts.

Level 4

• Drive and implement complex and critical analytic initiatives with minimal oversight. Includes working independently on creating timelines, working with other areas to define deliverables, monitoring progress, implementing the project and resolving/monitoring post-implementation issues.
• Represent the department when meeting/strategizing with leadership of other areas, practicing situational awareness and balancing the business needs with prioritization of analytics resources.
• Review results post-implementation to ensure projections are realized and recommend modifications as applicable.
• Incorporate strategic planning in all areas of responsibility, collaborating with internal business partners to define and execute strategy or direction.
• Participate in leading overall strategic direction and execution of data, analytical and reporting capabilities, tools, outputs, insights and business/clinical interpretation and advisory services.