Medical Economics Consultant

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

• Analyze the financial performance of all Horizon BCBS products, including Commercial, Medicare, and Medicaid, identifying favorable and unfavorable trends, and develop recommendations to improve trends, communicate recommendations to management.

• Develop insights and recommendations based on your work and deliver executive level presentations to educate and build support for needed changes.

• Perform drilldown analysis into claims trend to identify actionable items focusing on cost and utilization measures across member and provider demographics and cost categories.

• Provide data driven analytics to various teams including, Medical Management, Network, and other departments to enable critical decision making.

• Support Financial Analysis projects related to medical and provider cost reduction initiatives.

• Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports.

• Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes, including contract changes with hospital, ancillary and physicians.

• Develop reports that analyze cost trend on provider level and communicate recommendations to HNS teams including Network Contracting and Care Management.

• Develop, maintain, and automate your own reporting from available data sources using a combination of analytical and financial analysis techniques

• Leads the Healthcare Management Reporting process (partnering with analytics and actuarial) aimed at the presenting and understanding P&L performance including, but not limited to: (i) Variance Analysis/Commentary - Actual vs Budget/Plan and Prior Year, (ii) Revenue detail and components, (iii) Medical Cost detail and trend drivers, (iv) Performance of Medical Cost Action Plans, (v) Product Mix and (vi) Market Segment financial results. Includes accountability for leading projects and initiatives to drive performance and enterprise-wide interfacing with business leaders and subject matter experts.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

• High School Diploma/GED required.

• Bachelor degree preferred or relevant experience in lieu of degree.

• Requires a minimum of 8 years of experience in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.

• Requires a minimum of 5 years of experience in Medical Cost Management & Analysis or other financial planning and analysis work.

• Requires minimum of 5 years of experience in developing complex financial models and reporting in order to drive analyses that will support business decisions.

• Requires analytical work experience within the healthcare industry (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)

• Requires work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis

• Requires strong problem solving and analytical skills; experience with relational database and techniques

• Requires advanced knowledge with Excel: Work experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/formulas; creating, using and interpreting pivot tables, filtering and formatting

• Requires knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue

• Requires knowledge of Government Program, Commercial, Medicare market sectors and products.

• Requires a demonstrated progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.

• Requires demonstrated understanding of P&L management principals, actual versus budget variance analysis, and general knowledge of budgeting and planning principals.

• Requires the ability to express thoughts clearly and concisely, both verbally and in writing.

• Requires a demonstrated aptitude for analytical thinking and the ability to report findings in an accurate manner.

Travel: 15 %

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.