Healthcare Economic Consultant Job Description
Healthcare economic consultant
provides subject matter expertise related to healthcare policy, guidelines, payment regulations and Medicare and Medicaid claims data.
Healthcare Economic Consultant Duties & Responsibilities
To write an effective healthcare economic consultant job description, begin by listing detailed duties, responsibilities and expectations. We have included healthcare economic consultant job description templates that you can modify and use.
Sample responsibilities for this position include:
Plans and tracks projects working with large data sets and making data-driven analytical decisions
Understanding of healthcare payment methodologies and policies coding is recommended
Research data quality questions
Size Fraud and Abuse Expansion Concepts for potential opportunity and savings
Monthly analysis of rule performance
Screen scrape and automation ideation providing Data Analyst support for existing automations and scrapes
Utilizing data mining tools
Understanding healthcare payment methodologies and policies coding is necessary
Good understanding of medical claim terminology for example
An understanding of healthcare payment methodologies and policies coding is necessary
Healthcare Economic Consultant Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Healthcare Economic Consultant
List any licenses or certifications required by the position: AHIMA, AAPC, CCSP, SAS
Education for Healthcare Economic Consultant
Typically a job would require a certain level of education.
Employers hiring for the healthcare economic consultant job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Economics, Finance, Statistics, Health Administration, Medical, Health Care, Mathematics, Accounting, Graduate, Computer Science
Skills for Healthcare Economic Consultant
Desired skills for healthcare economic consultant include:
Commercial health plan and payment methodology
Medicare
Statistical methods used in the evaluation of healthcare claims data
UHC systems desk top applications
Medicaid and /
Claims processing
Medicaid
Business ecosystem
Processes and trends
Client Reimbursement Policy
Desired experience for healthcare economic consultant includes:
Advanced level of experience working with MS Excel including formulas, calculations, charts, graphs
Knowledge of UHC systems desk top applications
Knowledge in Laboratory claims and Lab pricing
Master's Degree in Mathematics, Statistics, Economics, Computer Science, Public Health, MBA or a related quantitative discipline
Proficient with excel to include pivot tables, foundational formulas, charts
Performs statistical and trend analyses to determine effectiveness of clinical programs
Healthcare Economic Consultant Examples
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Healthcare Economic Consultant Job Description
Job Description Example
Our growing company is hiring for a healthcare economic consultant. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for healthcare economic consultant
- Serves as a Senior Healthcare Economics/Analytics consultant for national and local market projects
- Communicates results to relevant audiences and customers and incorporates results into financial forecasts, if applicable
- Generate functional business requirements used for various processes, analytic development, strategic reporting, and system navigation (SOPs, BRDs, PRDs, HLDs )
- Subject matter expert (SME) as it relates to healthcare capitation, accounts receivable, utilization, claims, and financial accounting data
- Analyze and extract data from the Enterprise Data Warehouse (EDW) to report to internal and external customers
- Serve as a key resource to finance teams by providing data/analytical support, mentoring, guidance and technical expertise
- Design, develop, test, document, and maintain database queries for ad hoc reporting used in complex conceptual analyses
- Develop systematic reporting processes and procedures to ensure timely delivery of weekly, monthly, quarterly, annual, and ad hoc reporting to management
- Manage reporting and analysis elements on all business initiative projects
- Recommend and implement new or modified reporting methods and procedures to improve report content and completeness of information
Qualifications for healthcare economic consultant
- Intermediate proficiency working with MS Excel including formulas, calculations, charts, graphs, pivots
- Experience in leading, tracking and planning projects
- Undergraduate degree in Math, Economics, or Statistics
- 3+ years of data experience working with large datasets / big data
- 3+ years of data analysis / programming experience
- Experience using Tableau Reporting and / or other similar visualization software
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Healthcare Economic Consultant Job Description
Job Description Example
Our growing company is hiring for a healthcare economic consultant. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for healthcare economic consultant
- Develop innovative approaches to achieve deliverables and increase efficiencies
- Function as a team lead, overseeing the work of others within designated teams
- Calculate financial impact through valuation model for Final and March sweep
- Load and maintain rate tables
- Load and maintain Plan/pbp tables
- Produce monthly financial packages
- Produce monthly trending reports
- Development of data queries and extracts necessary for population health and network analytics data science initiatives
- Collects and understands historical data, and performs data analytics in support of trend identification, initiative, program development and financial performance
- Use medical economics experience and knowledge to facilitate idea generation and quantification of savings initiatives (areas of focus include provider contracting, utilization management, care management, risk adjustment, operational efficiencies, product design)
Qualifications for healthcare economic consultant
- Experience with other Business Intelligence Tools like Cognos, TOAD
- 1+ years of health care clinical experience working with a provider
- Must be comfortable with presenting
- 4+ years of proficiency in financial and / or clinical healthcare analytics with an understanding of Medical claims detail
- At least an advanced level of proficiency in MS Excel (advanced formulas, pivot tables, macros, lists, statistical functions)
- Bachelor’s degree in Economics, Statistics, Finance, Health Administration, or related field
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Healthcare Economic Consultant Job Description
Job Description Example
Our growing company is looking for a healthcare economic consultant. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for healthcare economic consultant
- Regularly interact with Senior Finance leadership, including the Chief Actuary and CFO, other leadership and staff, to set and adjust overall goals and objectives of the process
- Consistently work with the business and functional area partners to develop a pipeline of new initiatives, seeking to achieve our multi-year financial improvement targets
- Communication – Explain complicated financial procedures, data problems and technical structure and solutions in a clear, concise, confident manner
- Data Retrieval – Pull data from very large legacy systems (using SQL or SAS) and join them together to provide workable data sets for analysis and problem solving
- Data analysis - Research questions raised by senior management regarding data and trends in data
- Problem Solving – Research issues in data quality and propose solutions to increase the accuracy of reporting
- Coordination – Work with operational team members to understand business processes and data needs
- Design – Design solutions and improvements for a legacy, structured, SAS-based data extracts system and communicate that design in specifications to developers
- Testing - Structure, perform & document large-scale testing within a prescheduled limited-release process
- Documentation – Document detailed (and sometimes tedious) specifications for developers, management and clients
Qualifications for healthcare economic consultant
- Proficiency with SAS and/or other statistical programs
- Proficiency with SAS and / or other statistical programs is a plus
- Proficiency with Tableau is a plus
- Intermediate experience with Claim Processing Systems (Facets, Xcleys, Galaxy, IKA, EZCap)
- Maintains working knowledge of CMS rules and regulations
- Bachelor’s degree in Economics, Statistics, Finance or Health Administration or related field
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Healthcare Economic Consultant Job Description
Job Description Example
Our growing company is hiring for a healthcare economic consultant. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for healthcare economic consultant
- Perform regular and repeatable data extraction, aggregation, and quality checking from multiple sources and tables in support of trend identification and root cause analysis
- Create reporting tool to investigate sources of variations
- Responsible for affordability including identifying trends and opportunities in healthcare spend and collaborating with functional leaders to implement initiatives
- Analyze and interpret various forms of utilization and healthcare cost data
- Research and understand national affordability initiatives and evaluate for feasibility in the Utah and Nevada markets
- Quantify initiative savings
- Perform the evaluation of payer proposals related to capitation arrangements and value-based contracts
- Analyze provider reimbursement arrangements, including capitation, hospital, physician and ancillary contracts
- Design and implement sound tools and applications to efficiently measure, monitor and forecast revenue from payers and reimbursement to providers
- Build strong relationships within the organization including financial, actuarial, network contracting and clinical operations areas
Qualifications for healthcare economic consultant
- Bachelor's degree, or in lieu of completed degree, 3+ years of professional experience working with claims data and medical codes
- Manage the Government division's projects related to government sponsored health and welfare programs
- Provide/lead detailed financial analyses and communicate the results for small- to large-scale projects
- Ensure project team is within budget, on time and producing work consistent with the scope
- Provide updates to the client team, gather additional information, coordinate data requests and advise client team on interim analyses
- Work on multiple projects with multiple clients simultaneously
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Healthcare Economic Consultant Job Description
Job Description Example
Our company is growing rapidly and is looking for a healthcare economic consultant. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for healthcare economic consultant
- Research and investigate key business problems through quantitative analyses of healthcare utilization and cost data
- Collaborate with business and technology departments to define deliverables and develop solutions that are reusable across the organization
- Conduct financial and provider network pricing modeling, analysis and reporting
- Analyze financial impact of provider contracts
- Analyze financial impact of corporate initiatives or external regulations
- Analyze financial impact of healthcare affordability initiatives
- Performs data analytics in support of unit cost trend identification, management, and mitigation
- Extracts and aggregates applicable data for measurement purposes
- Communicate results of financial impact and analysis to appropriate stakeholder groups
- Support new Care Delivery Organization data gathering and entity onboarding
Qualifications for healthcare economic consultant
- Intermediate level of proficiency in Excel (formulas, graphs, charts, pivot tables
- May directly supervise junior staff members and frequently provide supervisory feedback, training and mentoring to junior staff that have a project reporting relationship with them
- Contribute to the selling process with the senior client leader
- Keep self current on Health Policy environment and considers the implication of policy, law, political, changes impact client and client's programs
- Develop intellectual capital
- Minimum 7 years' experience in health data analysis, pricing, actuarial concepts or health underwriting