Senior Analyst Payer Analytics and Economics

CommonSpirit Health-posted 2 months ago
Mid Level
Remote • Rancho Cordova, CA
Hospitals
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This is a remote position. The Senior Analyst, Payer Analytics & Economics performs managed care financial analysis, strategic pricing and payer contract modeling activities for a defined payer portfolio. Provides analytical and pricing expertise for the evaluation, negotiation, implementation and maintenance of managed care contracts between CommonSpirit Health providers and payers. Recommends strategies for maximizing reimbursement and market share. Develops new managed care products with external payers that are consistent with approved strategic plans. Provides education to key stakeholders. Leads special projects for the senior leadership as requested. This position will serve and support all stakeholders through ongoing educational and problem-solving support for managed care payer reimbursement models. This position requires daily contact with senior management, physicians, hospital staff, and managed care/payer strategy leaders. The position must handle adverse and politically difficult situations, as the work may have a direct impact on individual physician incomes, along with directly impacting the financial performance of CommonSpirit Health. This role must be proficient in reading, interpreting, and formulating complex computer system programming/rules.

  • 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 and approve financial models and payer performance analysis.
  • Assure satisfactory contract financial performance.
  • Analyze and publish managed care performance statements and determine profitability.
  • Drive strategies and solutions in order to maximize reimbursement and market share, which have multi-million or multi-billion dollar impact to CommonSpirit Health.
  • Review and accurately interpret contract terms, including development of policies and procedures in support of contract performance.
  • Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
  • Analyze terms of new and existing risk and non-risk contracts and/or amendments/modifications using approved model contract language and following established negotiation procedures.
  • Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement.
  • Prepare complex 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, provisions, 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 (e.g.; Medicare/Medicaid/Payer websites).
  • Identify and access appropriate data resources to support analyses and recommendations.
  • Identify risk/exposure associated with various reimbursement structure options.
  • Gather data and produce analytical statistical reports on new ventures, products, services on operating and underlying assumptions such as modifications of charge rates.
  • Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities.
  • Maintain knowledge of operations sufficient to identify causative factors, deviations, allowances that may affect reporting findings.
  • Ability to translate operational knowledge to identify unusual circumstances, trends, or activity and project the related impact on a timely, pre-emptive basis.
  • Bachelor's Degree in Business Administration, Accounting, Finance, Healthcare or related field required or equivalent experience.
  • 2+ years 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.
  • Experience in contributing 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.
  • Basic technical understanding and proficiency in SQL, Oracle, MS Access, MS Visual Basic, C++, SAS, MS Excel, or other related applications.
  • Solid knowledge of fee-for-service reimbursement methodologies.
  • Working knowledge of healthcare financial statements and accounting principles.
  • Ability to use and create data reports from health information systems, databases, or national payer websites (Epic, EPSI, PIC, SQL Databases, etc.).
  • Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas.
  • Managed care knowledge/experience preferred.
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