Manager, Medical Economics
- Role
- Finance
- Experience
- Senior
- Employment
- Full-time
Open to US only. Set where you work from to check your eligibility.
No BS summary
Manager for medical economics to oversee membership and premium reconciliation. Requires 7+ years in healthcare analytics/medical economics, strong Medicare Advantage knowledge, and advanced Excel. SQL and Power BI/Tableau experience preferred.
Core skills
Required skills
Optional skills
ABOUT MATTER HEALTH
Matter Health delivers primary and preventive healthcare directly to older adults living in public housing communities.
Our mission is simple: to improve healthcare access by meeting patients where they are and building trusted relationships within the communities we serve. We are rapidly expanding across Tennessee and are seeking mission-driven professionals who thrive in fast-paced, people-centered environments.
Total Healthcare. Where you live.
ABOUT THE ROLE
The Manager, Medical Economics is responsible for Matter Health’s membership and premium reconciliation functions. This leader ensures enrollment, eligibility, and capitation revenue 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, Enterprise Information Management (EIM), and Operations to identify discrepancies, recover at-risk revenue, and improve data accuracy and integrity throughout the organization.
The ideal candidate combines deep healthcare analytics expertise with managed care knowledge, and thrives in a fast-paced, high-growth setting.
KEY RESPONSIBILITIES
- Lead 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 rate changes.
- Quantify revenue 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 root 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 close activities by validating premium revenue and explaining membership and premium variances.
- Conduct independent analyses and present findings and recommendations to leadership.
- Design scalable reconciliation processes and prepare to support the growth of an analyst team.
SUCCESS MILESTONES
First 90 Days:
- Gain foundational knowledge of Matter Health’s systems, data sources, and reconciliation processes.
- Assume ownership of the membership reconciliation process.
- Conduct initial gap analyses and identify areas for improvement.
Within 6 Months:
- Fully own membership reconciliation.
- Begin assuming responsibility for premium reconciliation processes.
Within 12 Months:
- Fully own both membership and premium reconciliation functions.
- Lead gap analysis and process improvement efforts related to medical expense data.
QUALIFICATIONS
REQUIRED
- Bachelor’s degree in Statistics, Mathematics, Economics, Computer Science, Healthcare Management, or a related field.
- 7+ years of experience in healthcare analytics, medical economics, or premium/membership reconciliation.
- Experience with healthcare, managed care, health plans, value-based care organizations, or healthcare analytics environments.
- Strong expertise in Medicare Advantage, healthcare analytics, and/or medical economics.
- In-depth understanding of healthcare 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 Excel proficiency and the ability to independently analyze complex 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 MATTER HEALTH
At Matter Health, we believe that where you live should never determine the quality of care you receive. Every team member is vital in improving healthcare access for older adults who have historically been underserved by traditional healthcare systems.
This isn’t just a mission statement — it’s the work we do, every day.
Total Healthcare. Where you live.
WORKING AT MATTER HEALTH
We’re committed to supporting our team both professionally and personally. Benefits for full-time team members begin on the first of the month after your start date.
Health & Wellness
- Medical, dental, and vision coverage
- Employer-funded HSA options
- Employer-paid life and disability insurance
- Voluntary illness, accident, and hospitalization coverage
- Access to Matter Health’s in-person and virtual care services
Financial Security
- Competitive compensation
- 401(k) with company match starting day 60
- Financial wellness resources and support
Time Away
- Up to 4 weeks of PTO
- 10 paid 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
Matter Health is committed to building a diverse and inclusive workplace. We welcome applicants from all backgrounds and experiences, and foster an environment where every team member feels valued, respected, and supported.
What you'll do
- Lead 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 rate changes.
- Quantify revenue 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 root 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 close activities by validating premium revenue and explaining membership and premium variances.
- Conduct independent analyses and present findings and recommendations to leadership.
- Design scalable reconciliation processes and prepare to support the growth of an analyst team.
What they require
- Bachelor’s degree in Statistics, Mathematics, Economics, Computer Science, Healthcare Management, or a related field.
- 7+ years of experience in healthcare analytics, medical economics, or premium/membership reconciliation.
- Experience with healthcare, managed care, health plans, value-based care organizations, or healthcare analytics environments.
- Strong expertise in Medicare Advantage, healthcare analytics, and/or medical economics.
- In-depth understanding of healthcare 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 Excel proficiency and the ability to independently analyze complex datasets.
- Ability to present analytical findings and recommendations to leadership.
- Strong analytical, problem-solving, communication, and relationship-building skills.
- Preferred: Experience with SQL.
- Preferred: Experience in premium reconciliation processes.
- Preferred: Managed care organization experience.
- Preferred: Experience building dashboards in Power BI or Tableau.
- Preferred: Knowledge of value-based care analytics and risk-based reimbursement models.
- Preferred: Previous leadership or team management experience.
Benefits
- Medical, dental, and vision coverage
- Employer-funded HSA options
- Employer-paid life and disability insurance
- Voluntary illness, accident, and hospitalization coverage
- Access to Matter Health’s in-person and virtual care services
- Competitive compensation
- 401(k) with company match starting day 60
- Financial wellness resources and support
- Up to 4 weeks of PTO
- 10 paid company holidays
- 2 volunteer days annually for meaningful causes
Matter Health is a value-based primary care organization dedicated to enhancing healthcare access for older adults living in affordable housing communities. By bringing primary and preventive care directly to where members reside, it removes barriers to care and establishes trusted relationships that lead to better health outcomes and improved quality of life.