The Business Analyst – Medical Cost Management is a critical part of the Bright HealthCare Finance team and is responsible for supporting the day-to-day process and functions of Bright’s Medical Cost Management team. This position will have responsibility for supporting financial analytics related to understanding root causes of trend drivers.  This position will work collaboratively with other teams to obtain supporting detailed records to assess opportunities to impact medical cost.  This position will also provide ad hoc support to leadership to review cost data to support insights and decision-making.

The successful candidate will be a self-starter and will have a proven track record of succeeding in fast-paced and complex health plan settings. You have a demonstrated ability to connect data analysis across multiple functional areas to actionable and measurable initiatives. You excel at seeing both the “big picture” and the detail necessary to ensure initiatives are being managed with high quality. You will have accountability; are an excellent verbal and written communicator; operate with strong attention to detail. Your colleagues and clients will recognize you for being a positive influence, having empathy towards others, being highly collaborative and strongly exhibit the ability to drive towards measurable outcomes.

ROLE RESPONSIBILITIES

1. Detailed reviews of financial and cost data to isolate trend drivers and identify actionable, root causes.
2. Review of paid claims data to assess the propriety of paid claims and related opportunities.
3. Work collaboratively with functional areas (analytics, network, clinical, operations, pharmacy, etc.) to articulate trend drivers and opportunities.
4. Provide supporting analytics to support understanding categorical components of cost at the minor market level.
5. Produce clear and concise summaries for ease of use by varied audiences.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
• Bachelor’s Degree in Accounting, Finance, Computer Science, Economics, Healthcare, or a related field
• Three (3) or more years of experience in analytical work within the healthcare industry specifically focusing on healthcare claims (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
• Experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vlookups and advanced functions/ formulas, creating, using, and interpreting pivot tables, filtering, and formatting.
• Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
• Working knowledge in creating and running complex queries using SQL or other programs (i.e. Visual Basic coding, etc.) is a plus, but not required.
• Experience creating data visualizations with Tableau, MS Power BI or other visualization tool(s).
• 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.

PROFESSIONAL COMPETENCIES
• Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.
• Demonstrated consistency in multi-tasking and planning for prioritizing workload with tight deadlines.
• Strong project management experience and ability to handle multiple projects in a fast-paced environment.

WORK ENVIRONMENT
Most work responsibilities are performed remotely carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.