Principal, Medical Economics

About the role

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

Responsibilities

• Lead and define statistical analyses to identify cost, utilization, and performance drivers across populations, markets, and payer arrangements.
• Partner with data, actuarial, and analytics teams to validate healthcare claims data structures, ensure data is accurately represented in enterprise datasets, and resolve discrepancies affecting downstream reporting and analysis.
• Apply economic insights to strengthen impact modeling and quantify the financial and operational implications of clinical and business initiatives.
• Develop experimental designs for new program initiatives to ensure programs are set up for impact analysis in advance
• Translate complex claims, reimbursement, and utilization data into clear, actionable recommendations for cross-functional stakeholders and senior leadership.
• Identify trends, anomalies, and emerging opportunities within claims and performance data, and communicate their implications for value-based care strategy.
• Required Qualifications
• Bachelor's degree in economics, statistics, mathematics, public health, healthcare administration, data science, or a related field; an advanced degree is preferred.
• 8+ years of experience in healthcare analytics, medical economics, actuarial analytics, or a related analytical function within the healthcare industry, with a focus on medical cost, utilization, or financial performance metrics. Experience with causal inference is preferred.
• Deep understanding of healthcare claims data structures, medical coding systems, and reimbursement concepts, including ICD-10-CM, CPT, HCPCS, DRGs, capitation, fee-for-service, and value-based payment models.
• Demonstrated ability to assess data quality, investigate discrepancies, and partner with technical teams to improve data integrity and usability.
• Strong SQL skills are required; experience with Python, R, or other analytical tools is preferred.
• Strong problem-solving, critical thinking, project management, and cross-functional collaboration skills, with the ability to influence stakeholders at multiple levels of the organization.
• Able to work effectively in a primarily remote environment:
• Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended
• Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role
• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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