Managed Care Payer Contract Analyst

Tribunus Health•Charlottesville, VA

4d•$90,000 - $125,000•Remote

About The Position

The Payer Contract Analyst is the analytical engine behind our work, providing crucial insights to support a variety of Tribunus accounts. The Analyst's mission is to perform robust scenario modeling and harness reimbursement data to inform managed care contract negotiations, monitor contract performance, and assess the impact of industry trends and government regulations. You will collaborate closely with Tribunus team members to understand their needs and act as a trusted analytics delivery partner to help maximize negotiation outcomes. The ideal candidate will have, throughout their career, demonstrated the ability to answer pertinent business questions using all available data assets and achieve targeted outcomes both individually and in team settings. Experience performing contract analytics in a hospital setting is required. If you have had to decide whether stoploss applies before or after the lesser-of-charges comparison, this role will feel familiar.

Requirements

Bachelor’s Degree Finance, Healthcare Administration, Business or related field.
5+ years in payer-related roles within the provider or insurance industry, including at least 3 years in net revenue reimbursement modeling, financial analysis, and performance computation.
Hospital contract modeling experience is required. You should be equally comfortable building expected-reimbursement logic from a contract and working inside a model you didn't write — including one a client or a payer built to support their own number.
Professional fee schedule modeling experience is also required.
Proficiency in contracting analytics, with the ability to harness reimbursement data to inform decisions and quickly assess a provider's value relative to its competitors.
Intermediate to advanced capabilities with Microsoft Excel and PowerPoint, along with experience building and manipulating Contract Modeling tools and extracting data from online databases (price transparency, etc.).
Strong project management skills, excellent attention to detail, and efficient conceptualization and logic skills.
Excellent written and verbal communication skills, including strong internal customer service orientation.

Responsibilities

Translate contract language into expected reimbursement and build flexible models that support scenario development, covering DRG case rates, tiered per diems, percent-of-charge, APC and EAPG outpatient methodologies, implant and high-cost drug carve-outs, and stoploss, outlier, and lesser-of-charges provisions; professional work spans conversion-factor and fee schedule arrangements. Models aggregate fee-for-service and value-based data from multiple sources.
Serve as an expert resource and trainer for colleagues on hospital and professional reimbursement methodologies and fee schedule analysis.
Lead relationships with applicable data vendors (price transparency, claim utilization, etc.) and disseminate information about updates and functionality improvements.
Analyze contracts and historical reimbursements to inform strategy and shape contract proposals.
When included in a client engagement, validate payer rate loads to ensure contracts are being executed accurately and perform root-cause analysis of variances.
Monitor payer policy updates and quantify the impact of potential material harm and other contract implications.
Serve as a resource to company leadership to assist in ad-hoc projects and update internal tracking systems as analytical work is completed.