Job Description
Analyze medical and pharmacy claims data to identify trends, cost drivers, and opportunities for optimization. Support provider contracting and payer negotiations by evaluating reimbursement models, pricing structures, and fee schedules. Develop financial models to assess payer performance, reimbursement strategies, and cost containment opportunities. Collaborate with sales and contracting teams to provide data-driven insights that support growth initiatives. Work with Medicare, Medicaid, and commercial claims data to track reimbursement trends and regulatory changes. Build reports and dashboards using SQL, Python, Power BI, or Tableau to visualize key business metrics. Evaluate the financial impact of alternative payment models, value-based care initiatives, and provider incentives. Ensure data integrity and accuracy in claims analysis to support strategic decision-making. Partner with internal teams to streamline claims processing, payment accuracy, and operational efficiencies.