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Minimum Qualifications
Possess Bachelor's Degree, and
At least two (2) years of experience doing medical economic analyses
A working knowledge of inpatient and outpatient medical industry operations or claims analysis to identify aberrant billing patterns
High level proficiency in: SAS, SQL, data mining software and Microsoft Office Suite, including Access Excel, Power Point and Word
Experience in accessing. Using and analyzing complex medical information databases
(A good working knowledge of Medicaid/Medical Assistance a plus, but not required)
'
Role Description:
Assist in the design and conduct of:
Fiscal and program analyses to support Pennsylvania Medical Assistance Program decision-making processes.
Analyses to support medical assistance business operating decisions and for tracking, reporting and controlling of Medical Assistance costs.
Analyses to support the development of effective provider network management and reimbursement strategies or identification of abuse or waste in the Medical Assistance program.
Cost benefit analyses for new Medical Assistance initiatives
Medical Assistance cost trend analyses by geography, services provider type, place of service and other factors to Client trends and suggest action plans.
Fiscal and impact analysis of potential cost containment initiatives.
Large data set analyses to determine whether targeted cost savings were achieved or to identify future savings targets
Analyses of various data sets to recommend payment levels and provide fiscal impact estimates
Development and maintenance of healthcare payment reconciliation systems
Participate in meetings to advise Commonwealth staff on work results.
Prepare summary level papers and defend analyses completed.
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