Senior Analyst Payer Analytics and Economics

Common Spirit-posted 4 months ago
Mid Level
Remote • Englewood, CO
Water Transportation
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This is a remote position with preferred Central time zone. Do you enjoy special projects on the more technical side of payer analytics and managed care? The person in this role will need to be very proficient with SQL queries, VBA and Excel and will help solution for requests on the more technical side of our contract modeling system. The Senior Analyst, Payer Economics performs complex managed care payer 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. Provides mentorship and guidance of Analyst contract modeling. Provides analysis findings and education to key stakeholders. 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.

  • Lead payer contract modeling strategy and consolidation for large managed care payer negotiations.
  • Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement.
  • Perform complex 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.
  • Monitor contract financial performance.
  • Analyze and publish managed care performance statements and determine profitability.
  • Review and accurately interpret contract terms, including payer policies and procedures impacting contract performance.
  • Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations.
  • Prepare complex service line reimbursement analyses and financial performance analyses.
  • Develop methods and models to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provision, parameters and rate structures aimed at establishing appropriate reimbursement levels.
  • Identify, collect, and manipulate data from a wide variety of financial and clinical internal databases and external sources.
  • 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.
  • Minimum of three (3) years of experience in financial healthcare reimbursement analysis is required.
  • Working knowledge of financial healthcare reimbursement analysis including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies.
  • Experience in contribution 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 MS Excel, MS Access, MS Visual Basic, PIC, SQL, or other related applications.
  • 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, PIC, SQL Databases, etc.).
  • Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas.
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