[Hiring] Sr. Medical Economics Analyst @Ennoble Care

Role Description

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.

Qualifications

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

Requirements

• 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

• 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.
• 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!