Healthcare Economics Manager

About the Company:

TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system.

Position Summary:

The Healthcare Economics Manager drives the execution of analytics to support the organization through analyzing key business issues related to cost, utilization and revenue for all risk clients. Lead the design and development of reports to monitor health plan performance and identify the root causes of medical cost trends. Drives innovation by creating tools to monitor trend drivers and provide recommendations for affordability opportunities. Prioritizes team workload, manages customer expectations and ensures alignment of deliverables with client needs and strategic objectives.

Roles and Responsibilities:

• Leadership responsibilities includes the hiring, development, and management of analysts
• Strong project management of team deliverables
• Perform drilldown analysis into claims trend to identify actionable items focusing on cost and utilization measures
• Support Financial Analysis projects related to medical and provider cost reduction initiatives.
• Responsible for developing data standards and ensuring data integrity by leading and managing data validation opportunities with internal and external clients.
• Ad hoc analytics and reporting duties to meet the needs of company resources and external customers
• Maintain documentation regarding analytics standards utilized by the team as well as client specific nuances
• Other duties as assigned

Education, Experience and Licensure:

• 5-10 years progressive experience in HealthCare Economics or Analytics roles with demonstrated expertise working with paid claims, eligibility, authorization, and other applicable data sets to support analysis
• Knowledge of healthcare data (claims, medical coding, providers, member eligibility, value based reimbursement etc.). Experience with utilization management processes and understanding of claims and UM datasets is highly valued.
• Strong SQL coding skills and general understanding of databases, schemas, ETLs
• Understanding and working experience with Power BI and/or Tableau
• General understanding of ETL process to support data engineering partners with quality reviews and data integrity validation
• Effective communication skills, both orally and in writing using language understandable to management and employees
• Demonstrated ability to understand complex healthcare financial, clinical, and operational issues
• Ability to think creatively to find solutions
• Precise attention to detail
• Bachelor’s Degree in Healthcare Analytics, Computer Science, Math/Statistics, or related fields

Preferred Skills:

• Customer Focus, Customer Service, Verbal Communication, Informing Others, Process Improvement, Problem Solving, People Skills, Teamwork, People Management, Managing Processes, Emphasizing Excellence.
• Strong organizational skills, excellent analytical skills, commitment to customer service; ability to problem solve; strong presentation skills throughout all levels of the organization.
• Proficient in Microsoft Office Suite software (Word, Excel, PowerPoint, Visio, Outlook, etc.).

TurningPoint Healthcare Solutions is an Equal Opportunity Employer.