Advisor, Medical Economics

ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community.

Requirements

• Identify, monitor, and analyze principal health care cost drivers, by market segment and/or by provider, including utilization and referral patterns and reimbursement rates
• Research healthcare delivery topics, analyze data, present results, and recommend solutions to address business challenges
• Analyze claims, membership, and prior authorization data to identify early signs of trends or other issues related to medical care costs and quality of care
• Provides actuarial support for Medicare Advantage plans by identifying trends and profitability drivers utilizing sound statistical methods
• Utilizes experience with HCCs and RAFs to forecast revenue projections
• Structure analytical results in an organized, visual manner to tell a meaningful, actionable story
• Work with Engineering team to source data, determine its credibility and usability, create end-user reports, and apply varying analytical techniques to solve specific business problems
• Perform ad-hoc requests from key stakeholders
• Interpret contractual language with a clear understanding of business rules and reporting requirements
• Execute other duties and special projects as needed, focusing on knowledge and skills development