Provider Financial Analyst II
About The Position
Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. This position will be responsible for compiling accurate and comprehensive prospective models to support hospital, physician and ancillary contracting as well as conduct cost impact reports for various Medica payment reimbursement initiatives. The position obtains necessary claims data from data programmers in order to accomplish modeling work. This position works extensively with the contract managers and contract implementation staff to review data for negotiations and administration of contracts. This position will also assist in researching issues raised by stakeholders. The preferred candidate will have some working knowledge of the health care industry, including an awareness of industry standard reimbursement methodologies, such as APR-DRGs, MS-DRGs, ASC Groupers, and CMS Physician rate resources. This position may also assist the manager in providing ongoing mentoring/coaching to fellow team members and represent the team in various committees as requested. This position may also develop particular focus on Medica’s expansion efforts into new markets outside of Minnesota. Development of skills and proficiency in reimbursement methods unique to our regional market will be a key to success in this position.
Requirements
- Bachelor's degree, or equivalent experience
- 3 years, or equivalent combination of education and experience
- Skilled with working with large data sets in MS-Excel
- Ability to work independently and analyze, coordinate, and document numerous projects
- Excellent communication and interpersonal skills; ability to work with all levels on a variety of financial issues
- Ability to determine root cause for discrepancies in modeled versus actual reimbursement
Nice To Haves
- 3 years of experience working with health care claims data
- Professional experience in data and process management
- Knowledge of claims systems and related claims payment methodologies
- Knowledge of provider contracts
- working knowledge of the health care industry, including an awareness of industry standard reimbursement methodologies, such as APR-DRGs, MS-DRGs, ASC Groupers, and CMS Physician rate resources
Responsibilities
- compiling accurate and comprehensive prospective models to support hospital, physician and ancillary contracting
- conduct cost impact reports for various Medica payment reimbursement initiatives
- obtains necessary claims data from data programmers in order to accomplish modeling work
- works extensively with the contract managers and contract implementation staff to review data for negotiations and administration of contracts
- assist in researching issues raised by stakeholders
- assisting the manager in providing ongoing mentoring/coaching to fellow team members
- represent the team in various committees as requested
- develop particular focus on Medica’s expansion efforts into new markets outside of Minnesota
Benefits
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
501-1,000 employees
