Pay for Performance Analyst

Hackensack Meridian Health•Edison, NJ

About The Position

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Pay for Performance (P4P) Analyst will be responsible for collecting, analyzing, and interpreting complex healthcare data to measure program effectiveness, identify quality improvement opportunities, and ensure accurate provider reimbursement based on performance metrics. This role requires a deep understanding of healthcare data standards, payment methodologies, and a commitment to advancing the quality and efficacy of patient care through data-driven insights. This role supports the development and execution of strategies that maximize program yields and minimize organizational risk. This role focuses on assisting with program oversight, data analysis, and reporting to ensure HMH achieves optimal outcomes in P4P and Value-Based programs.

Requirements

Bachelor's degree in healthcare administration, Business, or related field.
Minimum of 3 years of experience in healthcare operations, data analytics, or quality improvement.
Strong analytical and problem-solving skills.
Familiarity with healthcare quality measures and payer reporting.
Proficiency in data analysis tools and Microsoft Office Suite.
Effective communication and collaboration skills.
Ability to manage multiple priorities and meet deadlines.
Excellent written and verbal communication skills.
Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

Nice To Haves

Knowledge of private payer landscape and organizations.

Responsibilities

Program Support: Contribute to initiatives that help HMH place a larger portion of increases into P4P programs to sustain historical trend levels.
Technical Assistance: Apply knowledge of quality measures, hospital performance data, and best practices to support program optimization.
Program Monitoring & Reporting: Maintain understanding of definitions, metrics, and targets to provide daily oversight; prepare monthly summaries by payer, highlighting opportunities to reduce costs and improve performance.
Performance Tracking: Monitor cost and quality performance in real time to identify trends against risk, shared savings, and quality targets; track provider performance against P4P targets and quality indicators.
Payer Reconciliation: Assist with reconciling reports with payers on a monthly basis and support communication to demonstrate HMH's monitoring efforts.
Risk Management: Contribute to efforts that maximize shared savings and reduce exposure under downside risk contracts.
Data Analysis & Reporting: Conduct comprehensive analysis of KPIs related to cost of care, utilization, and quality performance across payer contracts; prepare dashboards and reports for management and stakeholders.
Reimbursement & Compliance: Review reimbursement data and payment rates to ensure compliance with federal and state requirements (HIPAA, Medicare, Medicaid); maintain compliance databases for all health plans and special projects; identify discrepancies and resolve complex claims and billing issues.
Process Improvement: Identify trends and opportunities for improvement and cost reduction; collaborate with clinical and administrative teams to implement and evaluate new initiatives.
Modeling & Forecasting: Develop financial and predictive models to support payer negotiations, contract modeling, and annual budget forecasting.
Documentation & Training: Maintain documentation of analytical processes and program targets; provide training and support to internal teams on quality standards and data use.
Revenue & Capitation Reporting: Produce, validate, and interpret data for health plan membership and capitation reports; develop internal status reports to meet organizational revenue goals; produce monthly payer revenue reports.
Data Integrity & Validation: Define data requirements, develop collection and analysis tools for payer-specific identities, perform validation to ensure reporting accuracy, and investigate discrepancies in data or workflows.
Utilization Analysis: Analyze PCP visits, ER visits, hospital admissions, and bed days to identify opportunities to control utilization.
Profitability Evaluation: Use collected data to evaluate payer relationships across lines of business, including Medicare and Medicare Advantage Five Star Performance, Medi-Cal Managed Care audits/compliance and incentives, and Commercial Health Plans P4P and HEDIS performance.
Cross-Departmental Support: Assist data analysis efforts of other FHCN staff and departments as needed.
Workflow Assessment: Evaluate the effectiveness of internal workflows on health plan revenue streams and ensure organizational policies align with contract terms.
Post-Production Planning: Maintain work plans for post-production reports and presentations.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.