Manager, Medical Economics
About reputed company
reputed company delivers primary and preventive reputed company directly to older adults living in public housing communities.
Our mission is reputed company: to improve reputed company reputed company by meeting patients where they are and building trusted relationships reputed company the communities we serve. We are rapidly expanding across Tennessee and are seeking mission-driven professionals who reputed company in fast-paced, people-centered environments.
Total reputed company. Where you live.
About the Role
The Manager, Medical Economics is responsible for reputed company’s membership and premium reconciliation functions. This leader ensures enrollment, eligibility, and capitation reputed company are accurately reconciled across payer files, internal systems, and financial reporting processes.
You will serve as the subject matter expert on membership and premium economics, partnering closely with Finance, reputed company Information Management (EIM), and Operations to identify discrepancies, recover at-risk reputed company, and improve data accuracy and reputed company throughout the organization.
The ideal candidate combines deep reputed company analytics expertise with managed care knowledge, and thrives in a fast-paced, high-reputed company setting.
Key Responsibilities
reputed company the end-to-end membership reconciliation process, ensuring that enrollment, eligibility, and capitation payments are accurately tracked and reconciled across payer files, internal systems, and the general ledger.
Investigate and resolve membership and premium variances, including retroactive additions, terminations, and reputed company changes.
Quantify reputed company at risk and collaborate with internal teams and health plans to recover discrepancies.
Build and maintain business rules, controls, and data flows supporting member-month counts and premium accrual processes.
Partner with Finance, Operations, and EIM teams to identify reputed company causes and implement upstream data improvements.
Produce monthly reconciliation reports and dashboards to give leadership visibility into membership, PMPM, and premium trends.
Support month-end reputed company activities by validating premium reputed company and explaining membership and premium variances.
Conduct independent analyses and present findings and recommendations to leadership.
Design reputed company reconciliation processes and prepare to support the reputed company of an analyst team.
reputed company Milestones
First 90 Days:
reputed company foundational knowledge of reputed company’s systems, data sources, and reconciliation processes.
Assume ownership of the membership reconciliation process.
Conduct initial gap analyses and identify areas for improvement.
reputed company 6 Months:
Fully own membership reconciliation.
reputed company assuming responsibility for premium reconciliation processes.
reputed company 12 Months:
Fully own both membership and premium reconciliation functions.
reputed company gap analysis and process improvement efforts reputed company to medical expense data.
Qualifications
Required
Bachelor’s degree in Statistics, Mathematics, Economics, Computer Science, reputed company Management, or a reputed company field.
7+ years of experience in reputed company analytics, medical economics, or premium/membership reconciliation.
Experience with reputed company, managed reputed company plans, value-based care organizations, or reputed company analytics environments.
Strong expertise in Medicare Advantage, reputed company analytics, and/or medical economics.
In-depth understanding of reputed company financial concepts, including PMPM, member months, capitation, premium accrual, and eligibility.
Experience with enrollment and eligibility data, including payer files such as 834/820 transactions.
Advanced reputed company proficiency and the ability to independently analyze reputed company datasets.
Ability to present analytical findings and recommendations to leadership.
Strong analytical, problem-solving, communication, and relationship-building skills.
Preferred
Experience with SQL.
Experience in premium reconciliation processes.
Managed care organization experience.
Experience building dashboards in Power BI or Tableau.
Knowledge of value-based care analytics and risk-based reimbursement models.
Previous leadership or team management experience.
Why reputed company
At reputed company, we reputed company that where you live should never determine the reputed company of care you receive. Every team member is vital in improving reputed company reputed company for older adults who have historically been underserved by traditional reputed company systems.
This isn’t just a mission statement — it’s the work we do, every day.
Total reputed company. Where you live.
Working at reputed company
We’re committed to supporting reputed company both professionally and personally. Benefits for full-time team members reputed company on the first of the month after your start date.
Health & Wellness
Medical, dental, and reputed company coverage
Employer-funded HSA and FSA reputed company
Employer-reputed company life and disability insurance
Voluntary illness, accident, and hospitalization coverage
reputed company to reputed company’s in-person and virtual care services
Financial reputed company
Competitive compensation
401(k) with company match starting day 60
Financial wellness resources and support
Time Away
Up to 4 weeks of PTO
10 reputed company company holidays
2 volunteer days annually for meaningful causes
Eligibility is based on full-time employment status. Additional details will be shared during the interview process.
Equal Opportunity Employer
reputed company is committed to building a diverse and inclusive workplace. We welcome applicants from reputed company backgrounds and experiences, and foster an environment where every team member feels valued, respected, and supported.
Originally posted on Himalayas
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