Medical Economics Consultant

at  AmeriHealth Caritas

Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.

EDUCATION/ EXPERIENCE:

• 1 to 3 years experience working in the Medical Informatics, Medical Economics, or related analytical positions at Managed Care Organizations.

OTHER SKILLS:

• Excellent communication skills
• Understanding of enterprise approaches to either MS SQL Server & related RDBMS technologies or MS Azure & related cloud computing data lake solutions
• Mastery of SQL
• Experience creating mega reporting projects & associated infrastructure from master data layers to enhanced clinical metrics that drive action
• Strong knowledge of the anatomy of healthcare claims and/or encounters
• Strong knowledge of health informatics terminology & classification schemes i.e. CPT codes, ICD-10 dx, common groupers like DRG’s, CCS, etc.
• Strong knowledge of industry standard population health & quality KPI like utilization per thousand, readmission rates, HEDIS metrics, etc.
• Strong knowledge of Excel
• Experience in a visualization tool like Power BI or Tableau
• Some knowledge of SAS or Python
• Strong interest in Medicaid

The position of Medical Economics Consultant reports to the Manager of Medical Economics & Business Process within Actuarial Analytics. This position is primarily responsible for developing large reporting layers, reports, executive decks, & enhanced metrics for our Total Cost Of Care (TCOC) revenue & expense review process. Additional responsibilities include meeting the business on actionability from insight by helping develop High Value Opportunities (HVO’s) that are in the millions of dollars in savings/revenue added & validating ongoing initiative savings methodology & accounting. Consultants have technical backgrounds & will create tools & reports that draw on disparate datasets follow departmental infrastructure & practices in order to generate a complete picture of our medical expense & revenue trends for primarily Medicaid by member cohort & claim category through the use of industry standard KPI. Consultants are expected to work with operational matrix partners to understand business processes in place to ensure reporting relevancy in addition to presenting findings to leadership in a clear & concise manner. Technology competencies include Azure Databricks, SAS, Python, MS SQL Server, Tableau, MS Power BI, Excel Data Models, or equivalent technologies.