Senior Medical Economics Analyst

5+ years of experience working within a payer or provider organization, or with healthcare analytics or care management organizations

Demonstrated experience across Commercial, Medicare (including MA), and Medicaid populations

Deep experience working the following types of data:

Enrollment and eligibility data

CMS revenue and risk adjustment data

Value-based performance datasets

Develop actuarially sound pricing models for Episodes of Care/Bundled Payments, Total Cost of Care (TCOC) programs, Shared Savings/Shared Risk arrangements, and sub-capitation and specialty value-based programs

Construct prospective and retrospective target-setting methodologies using difference-in-differences approaches, market benchmarking, credibility weighting, and risk-adjusted baselines

Evaluate financial and quality performance across Commercial, Medicare Advantage, and Medicaid lines of business

Support pricing validation, reconciliation modeling, and performance evaluation analyses

Develop and operationalize predictive models for cost, utilization, quality outcomes, and performance evaluation using random forest, gradient boosting (preferred), propensity score matching, logistic regression/GLMs, and/or multivariate and hierarchical modeling

Build provider performance classifiers and volume-based credibility frameworks