Provider Payment Analyst II

Partnership HealthPlan of California • Fairfield, CA

49d

About The Position

Under the direction of the Provider Payment Strategy Manager, this position will support thedevelopment, evaluation, and advancement of provider reimbursement methodologies to alignwith organizational strategies and objectives, including performance and alternative paymentapproaches, and advise executive-level leadership regarding the feasibility of various strategies.This position will require the utilization of a variety of methods, models, and data sources toevaluate potential reimbursement methodologies and rates, will provide organizational educationrelated to Partnership’s network provider reimbursement, act as a subject matter expert, inform thedevelopment, maintenance, and implementation of business unit policies and procedures, andperform other duties as assigned.

Requirements

• Bachelor's degree or above in Business Administration, ComputerScience, Healthcare Administration, or related field; minimum 4 yearsof experience working with a managed care organization or healthinsurer, in a provider contracting or analysis role; or an equivalentcombination of education and experience may be qualifying.
• Requires knowledge of State and Federal regulatory bodies, DHCS,CMS, DMHC, and NCQA, and Medi-Cal and Medicare benefits.
• Medi-Cal experience with a variety of contracting models usingcapitation, fee-for-service, per diem, case rates, risk arrangements andpay for performance.
• Knowledge of managed care concepts,contracting, reimbursement, data, policies, and procedures.
• Proficientin Microsoft Excel, Business Intelligence software, and databaseapplications.
• Valid California driver’s license and proof of currentautomobile insurance compliant with Partnership policy are required tooperate a vehicle and travel for company business.
• Excellent oral and written communication skills.
• Effectively negotiateand build consensus.
• Ability to be flexible, adapt to change, andprioritize assignments.
• Use good judgment in making decisions withinscope of authority and handle sensitive issues with tact and diplomacy.
• Apply HIPAA requirements and maintain confidentiality.
• Be sensitiveand supportive regarding PHC members and their medical needs
• Ability to use a computer keyboard.
• More than 75% of work time isspent in front of a computer monitor.
• Ability to move about thedepartment freely to assist with operational functions as needed.
• Whenrequired, ability to lift, move, or carry objects of varying size, weighingup to 20 lbs.

Nice To Haves

• Experience with physician/facility/ancillary reimbursementmethodologies is preferred.

Responsibilities

• Supports the development, evaluation, and advancement of provider reimbursementmethodologies to align with organizational strategies and objectives, including performanceand alternative payment approaches, and advises executive leadership regarding thefeasibility of various strategies and methodologies
• Utilizes a variety of methods and models to evaluate the feasibility ofreimbursement methodologies
• Provides support as a subject matter expert related to the provider reimbursementfunction and provides guidance on departmental operations
• Supports and informs the development and implementation of business unit policies andprocedures
• Performs other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees