[Hiring] Mgr, Medical Economics @Horizon Blue Cross Blue Shield of New Jersey

Role Description

Provides support and consultation to the Health and Network Solutions (HNS) through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. Design and develop reports to monitor and identify the root causes of Medical and Provider cost trends. Collaborate with cross functional teams to identify opportunities to help bend the medical cost curve. Identify opportunities to reduce manual processes and interventions and develop systemic solutions to drive efficiency.

What You'll Do

• Develops analytics to evaluate the performance of medical and provider cost activities across Health and Network Solutions (HNS) and consults with business leaders on observations and recommendations.
• Identifies favorable and unfavorable trends, develops recommendations to improve trends, communicates recommendations to management, and analyzes the financial performance of all Horizon BCBS products, including Commercial, Medicare, and Medicaid.
• In partnership with the director, directs the development and implementation of advanced analytic tools and techniques to identify cost drivers and ways to improve medical and provider cost performance.
• Expands the evaluation of provider performance, benchmarking providers across multiple cost of care categories, and provides input and recommendations to contracting teams to guide contract negotiations, network strategy, and overall enterprise understanding of provider performance.
• Partners with the director and collaborates with finance and actuarial teams to connect medical and provider cost activities to the enterprise processes including forecasting, budgeting, and pricing.
• Supports the director in maintaining effective internal controls over the processes and transactions under areas of responsibility, including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.
• Identifies opportunities to reduce manual processes and interventions and develops systemic solutions to drive efficiency.
• Manages, develops, and trains staff; develops and monitors goals; conducts annual performance reviews, and administers staff salaries.

Qualifications

• High School Diploma/GED required.
• Bachelor degree in math, statistics, actuarial, finance, accounting, economics, business administration or a related field preferred or relevant experience in lieu of degree.
• Minimum of 5 years of experience in developing complex financial models to support business decisions.
• Minimum of 3 years experience with Advanced SAS and/or SQL, including creating queries, pulling large data sets, and performing data manipulations/analysis.
• Minimum of 5 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.
• Demonstrated experience leading big projects with cross-functional departments at various levels.

Requirements

• Knowledge of Government Program, Commercial, Medicare market sectors and products.
• Ability to communicate complex concepts to a non-technical audience in a digestible manner using data visualization.
• Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM), and revenue.
• Advanced knowledge with Excel, including working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/formulas, and interpreting pivot tables.
• Demonstrated aptitude for analytical thinking and the ability to report findings accurately.
• 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.
• Strong problem-solving and analytical skills; experience with relational databases and techniques.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Salary Range

$109,600 - $149,625. This compensation range is specific to the job level and takes into account various factors, including education, experience, licensure, certifications, geographic location, and internal equity.