Associate Director, Medical Economics & Informatics (Actuary) (Remote)

HealthHelp – A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp’s staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

SUMMARY

The primary responsibility of the Director of Medical Economics is to direct and administer the compilation, analysis, validation and dissemination of healthcare information to the customer.  This requires an understanding of healthcare and customer-specific data; defining of customer business requirements; design and creation of required reports and analyses; and distribution of results back to the customer.

 

Essential Duties:

§  Establish and maintain effective relationships with customers (internal and external) by determining the customers’ business requirements and looking for new ways to provide value to the customers.

§  Support Corporate Development efforts related to Sales and Implementation.  Analyze Pre-Engagement Reports, providing an Executive Summary with key findings and detailing opportunities for intervention.

§  Receive, record and assign all requests.  Translate the customers’ business needs into data/systems requirements.  Prioritize and manage concurrent projects in order to meet deadlines and ensure customer satisfaction.

§  Direct and administer the compilation, analysis, validation and dissemination of healthcare information to the customer.  Perform data validation and process verification to ensure accuracy and appropriateness of reported information.  Ensure documentation of all reports and analyses.

§  Hire, train, supervise and evaluate staff.  Coach, develop and mentor direct reports.  Assist them in obtaining a better understanding of how to turn business requirements into meaningful reports and analyses.

§  Assist with the preservation and continuous development of an accurate Data Warehouse.  Ensure the integrity of data extracts used in reporting and analysis functions.

§  Conceptualize, design and validate reports to meet routine identified needs.  Ensure data is methodologically and statistically sound and that reporting is meaningful and accurate.  Work with IT to automate reports.

§  Perform complex data extractions and manipulations, which culminate in the design and production of meaningful ad-hoc analyses and/or reports as needed.

§  Identify methodologies to determine variances that are statistically significant for over- and under-utilization.

§  Develop methodologies for the creation of benchmarks.

§  Establish and ensure compliance with departmental policies, procedures and standard methodologies.

§  Perform other duties as assigned.

§  Bachelor’s Degree or Master’s degree with a major in health economics, statistics, epidemiology, health administration or public health preferred or equivalent experience. Must have ASA or FSA designation.

§  Minimum of seven years’ experience in a healthcare (insurance, managed care, hospital, pharmacy, or academic research) analytic or reporting environment required, with at least five years in a management capacity.

§  Knowledge of health system functions as well as healthcare industry terminology and standard coding systems including ICD-10-CM, CPT-4, HCPCS and revenue codes required.

§  Superior data manipulation and analytic skills with excellent ability to understand and interpret healthcare data.  Knowledge of Radiology coding and claims data a plus.

§  Above-average proficiency with multiple computer programs.  Advanced knowledge of computerized query and reporting tools, statistical analysis tools and relational databases required.

§  Strong quantitative, analytical, problem solving, organizational, leadership and interpersonal skills are required.  Attention to detail is a must.

§  Excellent oral and written communication skills.  Able to communicate effectively with technical personnel as well as all levels of customer management including, but not limited to senior management.

§  Must work and lead effectively in interdisciplinary teams and be able to interact with a variety of staff members throughout the organization.

§  Ability to prioritize and manage concurrent projects, demonstrate initiative and creativity and work independently.  Prior project management experience a plus.

§  Ability to recognize potential and actual problems, develop solutions and implement an effective course of action.

§  Knowledge of HCFA, HEDIS and NCQA principals and standards helpful.

All your information will be kept confidential according to EEO guidelines.