Enlacehealth
Senior Medical Economics Analyst
Atlanta, GA. Posted 8 months ago
The role
The Senior Medical Economics Analyst will support the design, evaluation, and optimization of value-based pricing and performance frameworks. This role works across Commercial, Medicare, and Medicaid populations using actuarial methods and predictive analytics.
What you will do
- Support pricing validation, reconciliation modeling, and performance evaluation analyses
- Construct prospective and retrospective target-setting methodologies
- Evaluate financial and quality performance across Commercial, Medicare Advantage, and Medicaid lines of business
- Develop and operationalize predictive models for cost, utilization, quality outcomes, and performance evaluation
- Support steerage, network optimization, and care management analytics
- Perform medical cost trend decomposition
- Conduct risk-adjusted PMPM analysis across specialties, site-of-service, and population segments
- Analyze longitudinal performance across defined assessment periods
- Quantify impact of specialty utilization patterns and referral dynamics
- Write advanced SQL queries to construct datasets
Required qualifications
- Bachelor's degree in a STEM field, or equivalent work experience
- 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
- Experience working with medical claims data
- Experience working with enrollment and eligibility data
- Experience working with provider data
- Experience working with CMS revenue and risk adjustment data
- Experience working with value-based performance datasets
- Strong proficiency in SQL, Tableau, and Excel
- Must be legally authorized to work in the US
Nice to have
- Master's degree
- Experience utilizing Python or R
Benefits
- FREE medical, dental, and vision insurance for employees on select plans
- $1740 annual contribution into qualifying HSAs
- UNLIMITED time off
- Matching 401(k) plan
- Mac laptop and accessories
- Company-paid short-term and long-term disability
- Company-paid life insurance
- Employee Assistance Program
- Annual professional development stipend
About the company
Enlace Health is a specialty value-based care company focused on reducing the cost of care in specialty services. The company operates across 80+ markets.