Sr. Medical Economics Analyst

Position Overview

We are seeking an experienced Sr. Medical Economics Analyst to join our value-based care (VBC) team in our Accountable Care Organization (ACO). This role requires a seasoned professional with 3-5 years of data analytics experience who can navigate the complex landscape of Medicare risk models, value-based care arrangements, and population health analytics. The ideal candidate will play a critical role in optimizing our organization's performance under CMS total cost of care models while ensuring sustainable financial outcomes.

Key Responsibilities

Risk Assessment & Medicare Analytics

• Develop and maintain sophisticated risk-adjusted provider group performance models using CMS-HCC methodology.
• Analyze VBC performance under various CMS and CMMI total cost-of-care models.
• Monitor and forecast financial performance across assigned patient populations.
• Conduct comprehensive claims analysis using CCLF (Claims and Claims Line Feed) and BCDA (Beneficiary Claims Data API) datasets, including simulating CMS-HCC risk adjustment.

Data Management & Analytics

• Process and analyze large healthcare datasets, combining multiple data sources including EHR systems and Medicare claims data.
• Ensure data quality and integrity across all analytical processes.

Business Intelligence & Reporting

• Create fit-for-purpose analytical reports that translate complex actuarial findings into actionable business insights.
• Develop executive dashboards and performance metrics aligned with organizational strategic goals.
• Present findings and recommendations to leadership teams and clinical stakeholders.
• Support budget planning and financial forecasting processes.

Regulatory Compliance & Process Improvement

• Stay current with evolving CMS and CMMI program requirements and quality measures.
• Collaborate with revenue cycle and coding teams to optimize documentation and billing accuracy.

Required Qualifications

Education & Certification

• Bachelor's degree in Data Science, Statistics, Mathematics, Economics, Business Administration or related quantitative field.

Experience Requirements

• 3-5 years of data analytics experience, preferably in healthcare or Medicare-focused environments.
• Thorough understanding of and hands-on experience with Medicare risk adjustment and CMS-HCC models.
• Demonstrated experience working with CMS and CMMI total cost of care (ACO) programs.
• Proven track record analyzing Medicare claims data, specifically CCLF and BCDA datasets.
• In-depth knowledge of healthcare billing processes from both provider and CMS perspectives.

Technical Proficiency

• Advanced proficiency in Microsoft Excel (pivot tables, complex formulas, VBA preferred).
• Strong SQL skills with ability to write complex queries and optimize database performance.
• Experience with Microsoft Azure cloud platform and related analytics tools.
• Proven ability to work with very large datasets (multi-million row files) and combine data from multiple sources.
• Experience integrating EHR data with claims datasets for comprehensive population health analysis.

Core Competencies

• Exceptional analytical and problem-solving capabilities.
• Strong business acumen with the ability to translate technical findings into strategic recommendations.
• Excellent written and verbal communication skills for both technical and non-technical audiences.
• Proven team player with a collaborative approach to cross-functional projects.
• Demonstrated capability to understand and respond to evolving business needs.

Location: Fully Remote (with up to 10% travel).

This position requires the ability to work with sensitive healthcare information and maintain strict confidentiality in accordance with HIPAA and other applicable regulations.

Benefits

Full-time employees qualify for the following benefits:

• Medical, Dental, Vision and supplementary benefits such as Life Insurance, Short Term and Long Term Disability, Flexible Spending Accounts for Medical and Dependent Care, Accident, Critical Illness, and Hospital Indemnity.
• Paid Time Off.
• Paid Office Holidays.

All employees qualify for these benefits:

• Paid Sick Time.
• 401(k) with up to 3% company match.
• Referral Program.
• Payactiv: pay-on-demand. Cash out earned money when and where you need it!

Candidates must disclose any current or future need for employment-based immigration sponsorship (including, but not limited to, OPT, STEM OPT, or visa sponsorship) before an offer of employment is extended.

Ennoble Care is an Equal Opportunity Employer, committed to hiring the best team possible, and does not discriminate against protected characteristics including but not limited to - race, age, sexual orientation, gender identity and expression, national origin, religion, disability, and veteran status.