The company is looking to solve the problem of analyzing medical and pharmacy claims data to support contract negotiations, provider reimbursement strategies, and sales initiatives in the healthcare industry.
Requirements
- Strong knowledge of Medicare and commercial payer reimbursement methodologies.
- Experience with medical and pharmacy claims data, provider fee schedules, and healthcare financial modeling.
- Proficiency in SQL, Python, R for data analysis.
- Familiarity with contract negotiations, network management, and provider relations is a plus.
- Experience with Power BI, or Tableau for data visualization.
- Experience with data analysis and financial modeling.
- Experience with healthcare claims analysis, payer analytics, or reimbursement modeling.
Responsibilities
- Analyze medical and pharmacy claims data to identify trends, cost drivers, and opportunities for optimization.
- Support provider contracting and payer negotiations by evaluating reimbursement models, pricing structures, and fee schedules.
- Develop financial models to assess payer performance, reimbursement strategies, and cost containment opportunities.
- Build reports and dashboards using SQL, Python, Power BI, or Tableau to visualize key business metrics.
- Evaluate the financial impact of alternative payment models, value-based care initiatives, and provider incentives.
- Ensure data integrity and accuracy in claims analysis to support strategic decision-making.
- Partner with internal teams to streamline claims processing, payment accuracy, and operational efficiencies.
Other
- Bachelor’s or Master’s degree in Healthcare Analytics, Statistics, Finance, Data Science, or a related field.
- 3+ years of experience in healthcare claims analysis, payer analytics, or reimbursement modeling.
- Excellent communication skills to present data-driven insights to stakeholders.
- Collaborate with sales and contracting teams to provide data-driven insights that support growth initiatives.
- Work with internal teams to streamline claims processing, payment accuracy, and operational efficiencies.
