Payer Analytics & Pricing Analyst

North Memorial Health Care

271d • $39 - $59

About The Position

Working directly with the Director of Payer Relations and Strategy, the Payer Analytics & Pricing Analyst is responsible for having a comprehensive understanding of health insurance payment methodologies and how changes to those methodologies, and the various components within, impact organizational revenue. This role is responsible for hospital and professional pricing, contract modeling, management, and evaluation of payer reimbursement methodologies and rates within contracts. The analyst will partner with the Revenue Integrity team, who is responsible for Epic Contract Build, to ensure the contracted methodologies and rates are being adhered to by our network payers by assisting in analysis of expected vs. actual payments.

Requirements

• BS/BA degree in healthcare, finance, business, computer science, public health, economics, or statistics, or an unrelated degree with at least 5 years' experience in healthcare managed care contracting build/analysis.
• 5+ years' experience with professional, hospital, and other billing and contract reimbursement performance analysis.
• Experience with hospital or clinic pricing strategy and analysis.
• Experience working at a health plan, hospital system, ACO, provider organization, consulting firm, or has previous analytics experience and capabilities.
• Experience working in a hospital or clinics healthcare organization.
• Experience modeling contract expected reimbursement in Epic, preferred.

Nice To Haves

• Knowledge of Payer Methodologies.
• Pricing Analysis skills.
• Advanced Excel Analysis skills.
• Experience with Epic HB and PB resolute, preferred.
• Experience with Epic Dashboards, preferred.

Responsibilities

• Understand health insurance payment methodologies and their impact on organizational revenue.
• Manage hospital and professional pricing and contract modeling.
• Evaluate payer reimbursement methodologies and rates within contracts.
• Collaborate with the Revenue Integrity team to ensure adherence to contracted methodologies and rates.
• Assist in analysis of expected vs. actual payments.

Benefits

• Public Student Loan Forgiveness program eligibility.
• 401k Retirement Match or Pension Plan, based on workgroup eligibility.
• Generous Paid Time Off (PTO) Plans.
• Adoption Reimbursement up to $3000 per child.
• Child Care Discount Program with New Horizon 10% off weekly childcare tuition.
• Education/Tuition Reimbursement.
• 24/7 Fitness Center Access for all benefit eligible team members.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree