Payer Analytics Economics Analyst
About The Position
As our Payer Analytics and Economics Analyst, you will be instrumental in leveraging data-driven insights to optimize our payer relationships, contract performance, and overall financial health. Every day you will analyze payer contracts, claims data, and market trends to identify opportunities for revenue enhancement, cost reduction, and improved contract terms. To be successful in this role, you must possess strong analytical, quantitative, and financial modeling skills, a comprehensive understanding of healthcare reimbursement methodologies, payer contracting, and managed care economics. Perform strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives. Develop financial models and payer performance analysis. Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability. Review and accurately interpret contract terms, including payer policies and procedures impacting contract performance. Provide stakeholder training of the modeling of proposed/existing negotiated payer contracts, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes. Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement. Prepare service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provision, parameters and rate structures aimed at establishing appropriate reimbursement levels. Identify, collect, and manipulate from a wide variety of financial and clinical internal data bases (e.g. PIC, STAR, TSI, PCON, EPIC) and external sources. Identify and access appropriate data resources to support analyses and recommendations.
Requirements
- Bachelors Other in Business Administration, Accounting, Finance, Healthcare or related field
- One (1) year of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies,
- Equivalent education and/or experience may be considered in lieu of degree.
- Experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and value-based provide reimbursement methodologie
- Experience in contribution to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations
Responsibilities
- Perform strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives.
- Develop financial models and payer performance analysis.
- Monitor contract financial performance.
- Analyze and publish managed care performance statements and determine profitability.
- Review and accurately interpret contract terms, including payer policies and procedures impacting contract performance.
- Provide stakeholder training of the modeling of proposed/existing negotiated payer contracts, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
- Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement.
- Prepare service line reimbursement analyses and financial performance analyses.
- Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provision, parameters and rate structures aimed at establishing appropriate reimbursement levels.
- Identify, collect, and manipulate from a wide variety of financial and clinical internal data bases (e.g. PIC, STAR, TSI, PCON, EPIC) and external sources.
- Identify and access appropriate data resources to support analyses and recommendations.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
