Medical Economics Resume Sample
Dustin Hirthe
9674 Flatley Stravenue,
Boston,
MA
+1 (555) 333 3188
Work Experience
Senior Medical Economics Analyst
09/2016
-
PRESENT
Dallas, TX
- Experience in healthcare industry and/or analytical modeling
- Design, develop, and implement statistically valid tests for internal and external assumptions for healthcare cost savings. Design methods that take into account the justifiable causes for variation in medical costs (age, sex, illness, severity, etc,) and develop reports that summarize this information in a way that management can use to make actionable decisions
- Contribute to planning by determining what information is necessary to make valid decisions, generating the necessary information, and analyzing the information and making recommendations
- Works with internal stakeholders to determine appropriate information for corrective action management reports. Prepares sophisticated financial analysis of proposed value based contracting initiatives, using raw data to create reports
- Prepare periodic deliverables and maintain internal process documentation
- Supports research and analysis of financial data, draws conclusions and provides consultation to internal and external partners for use in administering specific programs and processes related to medical expense and utilization
- Creates comparative views of unit cost information that Market and Shared Service contracting teams can utilize to identify outlier contracts
- Conducts ongoing monitoring of medical cost savings initiatives
- Supports the business units to identify trend outliers, analyze the trend drivers and perform the work necessary to facilitate the discussion on possible solutions
Medical Economics Analyst
07/2009
-
03/2016
New York, NY
- Performs detailed analyses, including accumulation of data, financial modeling, and reporting of outcomes
- Provides detailed analytics to provider network contracting teams in support of the negotiation process
- Develops ad hoc views of data that illustrates underlying trend issues for both cost and utilization
- Provide analysis of medical cost trends/drivers associated with the monthly MBR reporting in conjunction with the release of the monthly reports
- Participate in and/or facilitate identification, valuing and monitoring of company sponsored medical cost initiatives
- Link and explain historical results versus the financial forecast related to the initiatives
- Provide reliable and accurate MBR reporting
Medical Economics
11/2005
-
03/2009
Dallas, TX
- Work with the technical team to identify/implement improvements in quality control/timeliness of reporting
- Work with business owners to help markets understand their financial information
- Provide analysis of material changes in MBR levels from month to month in conjunction with the release of the monthly reports
- Link MBR reporting (recast) and financial forecast results
- Contribute to cross-functional teams to address key issues facing the organization
- Collaborate within finance (Actuarial/Accounting/Planning) to provide historical and prospective unit cost, utilization and other medical cost initiatives as critical inputs to the financial forecasting and monitoring process
- Build expertise in specific areas of medical cost management. Leverage this expertise across other markets and regions
Education
Cabrini University
2000 - 2004
Bachelor's Degree in Mathematics
Professional Skills
- Demonstrated skills with statistical analysis tool such as SAS and at least one reporting application such as MS Excel or MS Access
- Understanding of the healthcare industry, solid technical and communication skills, and ability to work in a fast-paced environment
- Use BI tools and SQL/SAS coding skills to support advanced analytic drill downs
- Experience working in healthcare provider analytics related to managed care contracting, revenue modeling, population management or financial decision support
- Demonstrates understanding of terminology, complex processes, and the suite of reporting applications that support financial and operational decision making
- Experience working in health plan actuarial, financial reporting or medical economics department or
- Some experience in preparing and delivering written and oral reports
How to write Medical Economics Resume
Medical Economics role is responsible for analysis, reporting, sas, finance, training, database, security, coding, design, research.
To write great resume for medical economics job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Medical Economics Resume
The section contact information is important in your medical economics resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Medical Economics Resume
The section work experience is an essential part of your medical economics resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous medical economics responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular medical economics position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Medical Economics resume experience can include:
- Coordinate and participate in research-related activities including industry best-practices, research and development of models, tools, and data analysis projects, and experience studies
- SAS/SQL programming skill is required
- Provide analytic support for provider profiling and comparative analysis in efficiency and effectiveness performance metrics
- Demonstrate a deep understanding of healthcare utilization and cost trends, leakage opportunities, network performance, and population risk profiles
- Experience with predictive modeling, advanced analytics tools (e.g. SAS, SPSS, etc.)
- Strong knowledge of other Microsoft applications including Access, Word, Visio, PowerPoint, and Outlook
Education on a Medical Economics Resume
Make sure to make education a priority on your medical economics resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your medical economics experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Medical Economics Resume
When listing skills on your medical economics resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical medical economics skills:
- Excellent data presentation, written and verbal communication skills
- Demonstrated project management experience with accountability for business results
- Demonstrated leadership and project management experience
- Expert level skills in the use of Excel pivot tables and advanced analytic functions; familiarity with the manipulation and analysis of large datasets
- Effectively communicate & negotiate across various levels
- Progressive experience in Medical Economics, Healthcare Underwriting, Finance, Accounting, or Analytics
List of Typical Experience For a Medical Economics Resume
1
Experience For Medical Economics Analyst Resume
- Build strong relationships with individuals by demonstrating the power of informatics
- Proven ability to work independently while also fully leveraging matrix relationships
- Experience in business reporting and analytical roles required
- Stewardship of existing Excel-based savings projection models and reporting tools, ability to leverage and develop new models and reporting tools as needed
- Analyst benchmarking data, reports, processes and measurements for key managed care indicators and compare to MMO actual results
- Familiar with Tableau Reporting
- Familiarity with concepts in provider contracts & contract modeling or the ability to quickly learn
2
Experience For Senior Medical Economics Analyst Resume
- Acts as catalyst through multiple layers to spark enthusiasm, collaboration and results. Never use the term “that’s how we always done it”
- Never use the term “that’s how we always done it”
- Manage the peer review process to ensure all reports are reviewed before distribution
- Communicate results and recommendations to Director, including prompt communication of any identified operational issues with the potential to negatively affect Health Choice’s profitability
- Provide timely and concise communication regarding ad hoc data requests
- Discuss financial results before completion of analysis reports
- Provide regular updates on project status and targeted completion time-frames
- Acts as catalyst through multiple layers to spark enthusiasm, collaboration and results. Never use the term “that’s how we’ve always done it”
3
Experience For Medical Economics Informatics Specialist Resume
- Enhance CGHB’s medical spend analysis and reporting capability to drive incremental value and in support of value add decision making; partner with finance
- Develop meaningful relationships with business partners by delivering quantitative and qualitative data and insights for Cigna’s value based initiatives
- Receive, interpret and complete data requests from Finance and other departments
- Lead requirement analysis, validation and verification, ensuring that requirement statements are complete, consistent, concise, comprehensible, traceable, feasible, unambiguous, and verifiable actionable
- Interprets business request, efficiently gathers data, and consistently formulates actionable conclusions within time constraints required to meet the business needs.
- Manages requirements traceability information and track requirements status throughout the project
- Participates in the peer review process to ensure all reports are reviewed before distribution
- Produce and monitor monthly trends in cost and utilization to explain drivers of financial results and highlight areas of opportunity for implementation of data-driven solutions to favorably impact medical costs improvement
- Evaluate monthly the financial contract results against budget and report profitability across provider groups and payors
4
Experience For Medical Economics Specialist Resume
- Utilize BI tools in designing dashboards, scorecards, and reports to track key healthcare efficiency metrics by Risk Unit, practice, physician and care management program. Communicate findings of performance trends and identification of areas of opportunity for performance improvement
- Perform analysis on population health utilization, cost, and management analytics as directed
- Gather data from multiple sources and develop necessary analytic data result sets to enable accurate and robust quantitative analyses
- Develop innovative approaches to deliver insightful analytic results that translate into actionable interventions and deployment of tactical clinical action plan
- Leverages MMO’s business intelligence tools that support analysis and reporting of member population health, provider profiling activities, and line of business product reporting
- Work cooperatively and collaboratively with staff at all levels across the organization
- Perform adhoc analysis as directed
5
Experience For VP Medical Economics Resume
- Responsible for medical economics analysis, connecting cause and effect of clinical actions on plan performance. Investigates claims and billing data and translate into utilization and cost trends, leakage opportunities, network performance, and population risk profiles would be key
- Actively collaborates with clinical leadership and institutes to drive clinical action on population health opportunities
- Liaison with Central Business Office to Identify PB Discrepancies: provide support and collaborate with the underpayment recovery team in the central business office to develop best practices for identifying, trending, quantifying and escalating payment discrepancies from contracted payers
- Managed Care and Business Analytic Reporting: design, create and maintain departmental managed care monitoring and analytic reports; conduct searches for relevant internal and external data sources that would be appropriate for enhancing analytics; research and incorporate best practices for data visualization methods and techniques
- Ad Hoc Business Development Projects: collaborate with UHealth executive leadership to provide decision support for new business ventures and product development; coordinate analysis with hospitals and clinical department leadership on projects requiring "intramural" analytics
- Managed Care Contract Modeling: Works with the senior analysts to develop new and renewal rate proposals during managed care contract negotiations
- Analysis and interpretation of financial information: produce accurate, timely, value-added analyses on medical claims and membership in support of national contracting initiatives
- Effectively communicate analytics and results to various matrix partners
6
Experience For Medical Economics Informatics Senior Specialist Resume
- Provide analysis on proposed rates and utilization targets; influence negotiation process to ensure targets are met / exceeded
- Partner with both internal and external business partners to understand financial levers, contract/program performance, & potential areas for improvement for our national vendor and ancillary contracts / programs
- Utilize independent judgment and discretion, identify trends, variances, and key issues and provide recommendations for adjustments as appropriate
- Production and distribution of quarterly dashboards in an accurate and timely manner
- Partner with vendors to work through reconciliations or other analysis projects
- Participates in JOC meetings
- Monitor progress toward internal targets that are set to mitigate medical cost trend
- Provides guidance to junior analyst as necessary
7
Experience For Senior Analyst, Medical Economics Resume
- Identify risk in contract language
- Experience with Structured Query Language (SQL) procedure as a data retrieval tool. Specifically, the ability to write programs to perform queries on data and retrieve data from multiple tables/sources with SAS and SQL
- Successfully prioritize and manage multiple responsibilities
- During planning phase: analyze variance to identify opportunities and risks; develop pro-forma scenario models of contracts and terms; create reports to guide negotiations with prospects
- At least five (5) years of experience to be considered for level II
- At least ten (10) years of experience to be considered for level III
8
Experience For Medical Economics Informatics Manager Resume
- During implementation: forecast performance results and support client-specific areas of interest
- Responsible for building health plan analytics focusing on health plan analytics that measure and improve enterprise financial performance
- During reconciliation: measure performance of our products across financial, patient satisfaction, and quality outcomes. Apply performance evaluation that fulfills contract terms and, when appropriate, the demands of rigorous outcomes research methodology
- Act as liaison/analyst for internal stakeholders, understand their needs and translate them into reporting and analytic solutions
- Analyze, research, and explain factors contributing to APM results and outcomes
- Drive decision making around proposed contract changes and financial evaluation of specific contract terms
- In depth claims analysis of baseline and ongoing contract monthly data
- Report production to support financial reporting and operations activities
- Identify necessary data and methodologies; collect, integrate, analyze and interpret data
9
Experience For Medical Economics & Actuary Services Supervisor Resume
- Strong analytical skills, with the ability to perform complex analysis and make recommendations based on statistical inferences. Experience with a wide variety of analytical or statistical methods
- Strong working knowledge of Business Intelligence products (Tableau, SAS, MicroStrategy, etc.)
- Demonstrated ability to articulate goals, plan and implement processes to achieve those goals, recognize and assess the implications of confounding variables, and meet deadlines
- Self-motivated with a demonstrated ability to work independently, and to exercise independent judgment in developing complex techniques or programs in a dynamic environment
- Experience in financial analysis and/or medical economics
10
Experience For Medical Economics Analyst, Senior Resume
- Provide Financial and Strategic support with Alternative Payment Models
- Provide analytic support of Clinical Pathways team
- Analyze cost of care for patients determined to be on or off pathway
- Acts as a subject matter expert in the area of medical economics in relation to Medicare and Managed Care
- Development of revenue and medical claims expense models for evaluating and projecting risk based contracts with health plan clients, ACOs and government partners
- Responsible for experience studies and medical trend studies
- Management dashboard report creation
List of Typical Skills For a Medical Economics Resume
1
Skills For Medical Economics Analyst Resume
- SAS/SQL or other data querying experience
- 2 - 4years of healthcare financial and analytical experience in a managed care setting
- Successfully Prioritize Competing Projects
- Experience in programming languages and BI software (such as SQL, SAS)
- Two years of financial healthcare analytical experience in a managed care setting, required
- Experience with claims data, pharmaceutical data and/or provider managed care
2
Skills For Senior Medical Economics Analyst Resume
- Experience designing visual analytics in a business intelligence (BI) platform such as Tableau and Microsoft BI tools
- Two years of work related experience
- Strong analytical ability and familiarity with advanced financial and healthcare concepts
- Three to five years related experience, required
- Working knowledge of SAS and/or SQL; knowledge of writing queries and analytical reports required
- Understanding of value based risk arrangements
- Working knowledge of financial analyses, cost accounting and reimbursement methods
3
Skills For Medical Economics Informatics Specialist Resume
- Working knowledge of financial analyses and reimbursement methods
- Expertise in multiple areas of provider contracting/reimbursement, analysis, modeling & reporting
- Some knowledge of reporting from databases using SAP Business Objects, SQL, SAS, R~studio or Python
- Some local area travel some early morning/late evening meetings none
- Some early morning and late evening meetings
- Proficiency in calculating standard healthcare metrics
- Knowledge of GAAP-based financial reporting and Sarbanes Oxley
- Knowledge of data processing software (Access, Excel, SQL)
4
Skills For Medical Economics Specialist Resume
- Extensive & diverse knowledge of healthcare data, metrics & coding structures
- Knowledge of Medicare pricing tools and Encoder Pro
- Review reporting and analysis projects
- Comfortable with numbers, data and analytics
- Understand and apply abstract concepts quickly
- At least three (3) years of leadership experience at a director, manager or equivalent level, leading a medical economics, healthcare actuarial informatics or analytics team
- Expensive experience with MS Word, PowerPoint, Excel and Access programs
5
Skills For VP Medical Economics Resume
- Comfortable working with high levels of ambiguity in an unstructured environment
- At least seven (7) years of
- Experience in managed care, ACO, value~based environment, physician practice operations, employer health benefits analysis or healthcare analysis firm with heavy data management components
- Moderate experience preparing management and physician scorecards and report summaries
- Knowledgeable about both the clinical and financial sides of managed care, including capitation, value~based arrangements, and pay~for~performance
- Work with data and attention to detail
- Collaboration across a matrix-environment
- 1) Manages a department with the following regional responsibilities: planning and forecasting medical costs; developing gross medical trend estimates; developing medical cost action plans; identifying overpayments; analyzing and communicating medical cost changes that impact reserves
- Proficient reporting from databases using SAP Business Objects, SQL, SAS, R~studio, Python or other query languages
6
Skills For Medical Economics Informatics Senior Specialist Resume
- Demonstrated success working with health care data, including physician and hospital claims, pharmacy claims, lab results and electronic medical record data streams
- Works well in teams
- Knowledgeable about both the clinical and financial sides of managed care, including capitation and pay~for~performance. Ability to work with data and attention to detail. Some experience in preparing and delivering written and oral reports
- Extensive experience with MS Word, PowerPoint, Excel and Access programs
- Skilled in business writing including narrative summaries of data, interpretation of results, and PowerPoint slide development (both graphical/tabular displays and summary of results)
7
Skills For Senior Analyst, Medical Economics Resume
- Experience with SSRS, Tableau, or other data visualization tools
- Some local area travel
- Conducts and coordinates cross-functional analysis of health care data to identify trends, explain plan results, and discover opportunities for plan improvement. Communicates findings to senior management and the appropriate stake-holders
- Proficiency in Microsoft Excel and SQL is required
- Knowledge of database applications, information systems processes, and ERP systems
8
Skills For Medical Economics Informatics Manager Resume
- Top Workplace in Northeast Ohio. Year after year we've received this recognition!
- On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!
- On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations
- Previous project or operational experience supporting UM, CM~related functions
- Experience working with health care utilization and quality data (an analyst for an Accountable Care Organization ACO, managed care, commercial payer, employer, physician group, or consulting group)
- Some local area travel, occasional early/late meetings
- Knowledge of relational database principles is a key aspect to this role, and can be demonstrated by experience with SQL, SAS, Access, or other database/data mining tools
- Actuarial experience welcome but not required
- Strong quantitative, analytic and problem solving skills to evaluate all aspects of a problem or opportunity to make or facilitate appropriate and timely decisions. This includes demonstrated experience creating complex spreadsheets containing such elements as Look-up tables, IF Statements, Pivot Tables
9
Skills For Medical Economics & Actuary Services Supervisor Resume
- Proficiency in Microsoft Office; SQL; SAS
- Quickly learn and use software BI tools
- Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms
- Understand detailed technical processes and create project specifications to support ongoing improvement of Cigna’s financial modeling capabilities and scale successful pilot programs
- Knowledge of data processing software (Access, SQL, SAS)
- Create SQL/SAS queries to pull and manipulate detail level data from a variety of supporting data tables for analytic research and investigation
10
Skills For Medical Economics Analyst, Senior Resume
- Understand Medical Cost Drivers
- Use raw data to create meaningful reports through working knowledge of relational database principles including SQL and MS-Office products (particularly MS-Access)
- Experience using diverse data management and analytic tools application (i.e. Access, Business Objects) required
- Knowledge of medical terminology and coding methodologies required. HCPC, CPT, RBRVS, Diagnosis (ICD-10), DRG's required
- Verbally communicate to employees and patients
- Proficient with PCs, Microsoft Office applications, systems databases and content management systems (such as SharePoint)
- Manage across teams and collaboratively coach junior analysts
- Translate business and clinical problems into analytic solutions
- Able to make sound decisions to drive solutions
List of Typical Responsibilities For a Medical Economics Resume
1
Responsibilities For Medical Economics Analyst Resume
- Effectively understand claims data, and billing systems, translate business and clinical problems into analytic solutions
- Participate in enterprise initiatives to improve population health effectiveness and outcomes
- Experience with report development, metrics management
- Responsible for all claims reconciliation and member reconciliation activities
- Develop insights and analysis to evaluate healthcare utilization trends. Present analyses to clinical leadership to help identity clinical interventions at patient segment level, regional level, provider level and enterprise level
- Review and draw conclusions to connect cause and effect of operational actions on enterprise population health financials and performance
2
Responsibilities For Senior Medical Economics Analyst Resume
- Build relationships with peers across enterprise on project teams and within domain of expertise
- Solve multiple parts of complex financial and utilization problems independently
- Structure and complete complex health care and medical economics analytics independently
- Determine key drivers of medical cost to assess financial exposure based on changes to business and contractual methodologies
- Proficiency in Microsoft Office: Excel, Word, Access; Outlook; SQL
3
Responsibilities For Medical Economics Informatics Specialist Resume
- Analyze emerging medical cost trends to understand the larger medical cost picture to provide timely insight into claim cost drivers for the business segment leaders and identification of new improvement opportunities
- Use medical economics and analytical experience and knowledge to facilitate idea generation and quantification of savings initiatives in areas of focus, such as provider contracting, utilization management, care management, risk adjustment, operational efficiencies, product design, etc
- Influence other departments without direct authority in coordination with other team members. Determine when projections seem unreasonable and constructively push back until satisfied with the analysis
- Consistently work with Health Plan business and functional area partners to develop a pipeline of new initiatives, seeking to achieve our multi-year financial improvement targets. Help drive a culture change from “reporting the past” to “creating the solutions for future.”
- Provide routine and ad hoc analytical support by re-pricing claims and creating financial impacts of how fee schedule and rate changes have retroactively and annually
- Monitor and respond to pricing inquiries, appeals and other issues related to fee schedules
4
Responsibilities For Medical Economics Specialist Resume
- Monitor, maintain and/or create fee schedules within approved service level agreement days
- Be an active participant in cross functional team meetings and calls
- Intermediate Other Ability to interpret an extensive variety of technical instructions
- Proficiency in Microsoft Office; SQL/SAS
- Proficiency in Microsoft Office: Excel, Word, Access, Outlook, Facets, Webstrat
- Proficiency in SQL/SAS, required
- Serves as a liaison between department’s analytical needs and technical data storage systems and files
- Technology Solutions Expert
- Consult and Education
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