AVP, Medical Economics - REMOTE

JOB DESCRIPTION Job Summary Provides strategy and leadership for team responsible for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance and outcomes. Collaborates with health plans to develop scoreable action item (SAI) tracking tools and identify opportunities to improve performance and data management, and support, guide and influence decision-making related to clinical programs, initiatives and strategy.

Essential Job Duties • Supports strategy development, vision and direction for the medical economics function including SAI analytics, governance and trend mitigation. Demonstrates accountability for performance and financial results, and keeps executive leadership apprised. • Provides oversight for medical economics team and activities - ensuring delivery of work/project plans, required reporting, development of SAI tracking tools and performance/data management improvement initiatives. • Recruits, hires, onboards, mentors, develops, and manages medical economics team of professionals. • Collaborates with leadership to develop and implement a companywide SAI governance process that moves through ideation, analysis, health plan review, approval, implementation planning and monitoring. • Identifies opportunities to improve health plan performance and data management. • Leads staff in SAI analysis, key performance indicator (KPI) reporting and tracking. • Implements tracking tool for trend mitigation items being worked between health plans and shared services (tools and technology). • Facilitates standardization of tools and view utilized in trend drill down process. • Leads staff in best practices across all areas of SAI development. • Coordinates SAI analyses that are completed outside of the MedEcon team - including payment integrity, national contracting, health care services and health plans. • Leads staff in vendor proposal review and performance review in support of vendor management team; consults with shared service partners on program improvement efforts and tracking. • Performs consistent follow-up on issues and opportunities identified. • Acts as thought leader for creation of additional data views for efficient analytics member level MLR, clinical condition and authorization views. • Stays abreast of professional developments and industry trends.

Required Qualifications • At least 10 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience. • At least 5 years management/leadership experience. • Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or related field. • Advanced understanding of Medicaid and Medicare programs or other health care plans. • Advanced analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) • Advanced proficiency with retrieving specified information from data sources. • Advanced experience with building dashboards in Excel, Power BI, and/or Tableau and data management. • Advanced knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) • Advanced knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form). • Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other