Provider Payment Analyst II

Partnership HealthPlan of California • Fairfield, CA

3d • $103,060 - $133,978

About The Position

Under the direction of the Provider Payment Strategy Manager, this position will support the development, evaluation, and advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including performance and alternative payment approaches, 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 to evaluate potential reimbursement methodologies and rates, will provide organizational education related to Partnership’s network provider reimbursement, act as a subject matter expert, inform the development, maintenance, and implementation of business unit policies and procedures, and perform other duties as assigned.

Requirements

• Bachelor's degree or above in Business Administration, Computer Science, Healthcare Administration, or related field; minimum 4 years of experience working with a managed care organization or health insurer, in a provider contracting or analysis role; or an equivalent combination 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 using capitation, fee-for-service, per diem, case rates, risk arrangements and pay for performance.
• Knowledge of managed care concepts, contracting, reimbursement, data, policies, and procedures.
• Proficient in Microsoft Excel, Business Intelligence software, and database applications.
• Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.
• Excellent oral and written communication skills.
• Effectively negotiate and build consensus.
• Ability to be flexible, adapt to change, and prioritize assignments.
• Use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy.
• Apply HIPAA requirements and maintain confidentiality.
• Be sensitive and supportive regarding PHC members and their medical needs
• Ability to use a computer keyboard.
• Ability to move about the department freely to assist with operational functions as needed.
• When required, ability to lift, move, or carry objects of varying size, weighing up to 20 lbs.
• Provide the highest possible level of service to clients
• Promote teamwork and cooperative effort among employees
• Maintain safe practices
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

Nice To Haves

• Experience with physician/facility/ancillary reimbursement methodologies is preferred.

Responsibilities

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

What This Job Offers

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