Healthcare Economics Consultant or Hospital Claims Data Analyst

About the position For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Optum is looking for a motivated, self-starter to join our Institutional Contracting Analytics team. In this role, you will support contract negotiations and unit-cost pricing initiatives for institutional provider types (ie. hospitals, skilled nursing facilities, ambulatory surgery centers). The HCE consultant will perform complex analysis using SQL and Excel to help lower the cost of care while improving quality. To succeed in this role, you will have excellent project and time management skills with a solid desire to learn as you grow. Have a basic understanding of facility and/or provider contracts and the key terms impacting quality and financial performance. The ideal candidate will have experience calculating key metrics for hospital cost and utilization (APK, PMPM). Advanced skills in SQL and Excel will be integral for day-to-day activities and being able to work in a fast-paced setting. Experience with the Microsoft Power Platform will also be helpful. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Responsibilities

• Provide support and analyses of provider contracting (hospital, ancillary, pharmacy, physician) and unit cost management activities
• Create detailed financial and network pricing models
• Perform regular and repeatable data extraction, aggregation, and quality checking from multiple sources and tables in support of trend identification, root cause analysis
• Assess and interpret business requirements and propose technical solutions
• Identify solutions to non-standard requests and problems
• Solve moderately complex problems and/or conduct moderately complex analyses
• Work with minimal guidance; seek guidance on complex tasks
• Translate concepts into practice
• Provide explanations and information to others on data availability, content and interpretation
• Research data quality questions; present findings; and suggest solutions as necessary
• Create custom data extracts and aggregation processes in support of one time studies
• Participate in projects by contributing to database creation, maintenance, and enhancement
• Create reporting tools to investigate sources of variations
• Produce and review reports

Requirements

• 2+ years of experience in health care data analytics (Financial and Quality analytics)
• 2+ years of experience with provider payment methodologies (i.e. fee for service or capitation)
• 2+ years of health care experience working with hospital claims data and medical coding (revenue codes, HCPCS/CPT codes, DRG, etc.)
• 2+ years of experience in network pricing OR finance experience
• Experience tracking trends, finding variances and developing reports in SQL and excel
• Experience building financial and pricing models in excel
• Experience working with large data sets
• Advanced level of proficiency working with MS Excel (PivotTables, SumIfs, Vlookup, etc.)
• Basic proficiency with SQL (Joins, filter data, etc.)

Nice-to-haves

• Hospital pricing and cost driver research and analytics experience
• Proven to be detail-oriented self-starter, critical thinker, with analytic skills and evidence of creative, proactive problem solving
• Proven ability to effectively manage multiple priorities

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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