Medical Economist- Associate (752792)

Minimum Qualifications

Possess Bachelor's Degree, and At least two (2) years of experience doing medical economic analyses A working knowledge of inpatient and outpatient medical industry operations or claims analysis to identify aberrant billing patterns High level proficiency in: SAS, SQL, data mining software and Microsoft Office Suite, including Access Excel, Power Point and Word Experience in accessing. using and analyzing complex medical information databases (A good working knowledge of Medicaid/Medical Assistance a plus, but not required)

Role Description:

· Analysis of GeoAccess and Gap analysis report submitted in Q1 2024.

· Monthly review of submitted Quality Improvement Plans (QIP)

· Review of weekly file submission of each CHC-MCO’s provider network for validations and remediations

· Review of weekly ‘snapshots’ produced by Deloitte/MEMM to see changes in each CHC-MCO’s network

· Comparative analysis between monthly submitted QIPs from the CHC-MCO to explain the gaps in each’s network.

· Analysis of the CHC-MCO’s explanation of the gap reasons including comparison to data and updates from the other 2 CHC-MCOs about changes in availability of providers.

· Provide feedback including analysis results to each CHC-MCO based on the findings of the QIP and snapshot analytics.

· Issuance of Corrective Action or Formal Improvement Plans based on the findings of the above stated analysis.

· On-going monitoring of issued Corrective Action Plans, Formal Improvement Plan for remediation

· Conducting ‘secret shopper’ campaigns to validate the reported availability of all provider types submitted by the CHC-MCO

· Monitoring changes in the provider networks as network churn effects the availability of providers in geographic areas.

· Develop, implement and support the implementation of the annual Network Access Criteria Exception Process. (approved for utilization in 2025)

· Improvements to the communication of technical assistance from OLTL and Deloitte to the CHC-MCOs.

· Pending Tasks from CMS

· CMS has released a final rule that significantly impacts all work done related to service accessibility in April 2024. These additional requirements are currently being evaluated by OLTL Policy for implementation in the near future.

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com