Healthcare Economics Manager

Overview

Location: Hybrid- WFH/Downers Grove 

Hours: Varied 

Must have prior Risk Score Experience

Good enough isn't for us. Duly Health and Care's team members show up every day driven to exceed expectations. We see and support the remarkable in every person within and beyond the walls of our work.

Duly Health and Care works to understand what matters most to you. We recruit and retain team members who share a relentless passion and pride for helping others live happier and healthier lives. We invest in helping our team members develop their talents in a way that is rich in personal meaning.  We invite you to join us, fulfill your purpose and make your mark!

Holistic benefits designed to help our team members flourish in all aspects of their lives, including: 

• Comprehensive medical and prescription drug benefits that include medical coverage at 100% (after deductible) when utilizing a Duly provider.
• $5,250 Tuition Reimbursement per year. 
• 40 hours paid volunteer time off. 
• A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact
• Wellness program that includes complimentary subscriptions to Noom and Calm apps. 
• 12 Weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members. 
• 401(k) Match
• Profit-sharing program 

Are you ready to challenge the expected to deliver the extraordinary?

This position is a key member of the Boncura analytics team contributing to overall organizational success by ensuring all constituents have the information they need to make key decisions timely and accurately.  This position is responsible for modeling VBC contracts to ensure all departments of the organization understand how to maximize the margin from VBC contracts. 

Responsibilities

The Journeys and Adventures that Await

• Areas of responsibility include: Financial modeling of proposed payor contracts and communicating impact to finance and contracting teams Financial modeling of proposed downstream contracts and validation that downstream payments by vendor, check, and procedure code are paid according to contract
• Manage the external reinsurance programs including comparing actual to expected recoveries, secure policies externally, make recommendation to program such as threshold changes Creation of policies to improve VBC contract performance by reducing total cost of care (e.g. utilization control, modeling high performing referral network) or increasing revenue through accurate HCC risk scoring Implement Medicare and Commercial risk scoring models:  either manage external purchasing or creation on internal risk score model from clinical and claims data Optimize Population Health programs by modeling appropriate patients for enrollment in case management and disease management programs.
• Lead team of  analyst that will develop contract financial impact and risk score models using healthcare medical and pharmacy claims, internal and external referrals, eligibility and attribution cohorts, diagnosis coding on billed and paid claims, to predict financial results from VBC contracts.  This includes identifying actionable items that would change operational protocols to maximize quality scores and other KPIs it relates to contract incentives that optimize earnings
• Create Predictive Analytics workspaceWork closely with IT/Data infrastructure leads to implement tools to develop a predictive analytics environment. Including but not limited to:Implement open source tools such as R or Python Creating data tables that combine clinical EMR data with paid claims data and demographic information for model building Develop team in modeling techniques Validate model results
• Manage Reinsurance and Subrogation ProgramCalculate expected recoveries to compare to actual, identify variances and update processes and policies accordingly Manage annual renewal with broker for external stop loss
• Develop team members' business knowledge and peer review all results released
• SUPERVISORY/MANAGEMENT SCOPE Manage analytics to support ACO success

Qualifications

The Experiences You Bring

• Bachelor's degree preferred. 
• Knowledge of VBC reimbursement methodologies strongly required!
• A minimum 5 years of healthcare reporting experience
• A minimum 3 years of experience with health care payer/provider contract auditing and health care cost analysis.
• Predictive Modeling building Prior experience with the health care claims process and electronic claims payment systems such as Epic Tapestry or health plan claims experience Industry knowledge of ICD-10, CPT, HCPC coding

MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES (KSA):

• Strong critical thinking and analytical / problem solving skills, comfortable with complex calculations and strong attention to detail.
• Advanced proficiency in Microsoft Office, SQL, and R or Python.
• Exceptional written and oral communication skills
• Understand professional, ancillary and institution medical claims reimbursement methodologies
• Experience working with paid medical claims data
• Demonstrate the ability to deal with the changing environment and to lead/facilitate and manage change efficiently and effectively where appropriate
• Knowledge of healthcare contract provisions and the implications for reimbursement

Employment Type: FULL_TIME