Senior Value-Based Contracting & Reimbursement Analyst
About The Position
Under general direction, the Senior Contracting and Reimbursement Analyst supports negotiation, analysis, administration, and financial evaluation of hospital and physician value-based payor agreements. The role combines value-based contracting expertise with net revenue analysis to help ensure contracts are financially sound, operationally executable, compliant with governmental requirements, and aligned with the system’s strategy. The analyst evaluates new and existing arrangements, including value-based and alternative payment models; prepares reimbursement analyses, cost report support, net revenue estimates, and financial forecasts; and coordinates contract implementation and audit activities. The role serves as a liaison among affiliates, finance, analytics, operations, and clinical stakeholders. Brown University Health employees are expected to role model the organization's values of Compassion, Accountability, Respect, and Excellence. Employees are also expected to demonstrate the core Success Factors: Instill Trust and Value Differences; Patient and Community Focus and Collaborate. The position is based at Corporate Headquarters, 15 LaSalle Square, Providence, Rhode Island. Work is Monday through Friday, 8:00 a.m. to 5:00 p.m., with an eight-hour workday. Driving is not required. Supervisory responsibility: none.
Requirements
- Bachelor's degree in accounting, finance, business, health care administration, or a related field, or equivalent education and experience.
- Comprehensive knowledge of health care finance, reimbursement, managed care contracting, contract administration, accounting principles, net revenue, cost reporting, and financial analysis.
- Knowledge of hospital and physician payment methodologies, capitation, risk arrangements, value-based contracting, alternative payment models, and governmental reimbursement principles.
- Strong analytical, financial modeling, negotiation, communication, project management, and problem-solving skills.
- Ability to interpret complex contractual, financial, regulatory, and operational information and communicate conclusions clearly to varied audiences.
- Advanced proficiency with Excel-based financial models and database tools.
- Three to five years of progressively responsible experience in a complex health care environment, with significant experience in managed care contracting, contract analysis and negotiation, third-party reimbursement, net revenue, financial reporting and analysis, budgeting, forecasting, cost reporting, or related areas.
- Demonstrated ability to work independently and manage multiple complex analytical and contracting priorities.
Nice To Haves
- Experience with Epic, EPSi, PeopleSoft, or comparable integrated financial systems.
Responsibilities
- Assist payor relations and contracting leadership with hospital and physician negotiations.
- Evaluate new and existing value-based arrangements, bundled payment models, shared savings agreements, and other alternative payment models.
- Coordinate timely contract execution, renewal, renegotiation, amendment, implementation, and distribution of relevant contract materials.
- Prepare and distribute value-based variance analyses, rate matrices, executive summaries, contract abstracts, and other documentation communicating financial and operational terms.
- Liaise with health plans, system affiliates, physician organizations, finance, operations, legal, analytics, and other stakeholders regarding contract terms, implementation, and issue resolution.
- Prepare and analyze financial and statistical data for governmental and third-party reimbursement reporting, affiliate and consolidated cost reports, net revenue schedules, month-end close, budgeting, forecasting, and settlement estimates.
- Analyze reimbursement methodologies, contract rates, payment terms, rate calculations, final settlements, pass-through payments, advance payments, and payer remittances to identify underpayments, overpayments, financial risk, and improvement opportunities.
- Quantify estimated reimbursement from governmental and commercial payors and support balance sheet and income statement adjustments for third-party settlement liabilities and receivables.
- Work with analytics and finance leadership to evaluate contract profitability, model financial impacts, monitor performance against contract terms, and develop methodologies to measure reimbursement changes.
- Price governmental and third-party reimbursement for new or expanded clinical programs and coordinate financial studies for new programs, product lines, service expansion, and contracting opportunities.
- Participate in developing the annual net revenue operating budget and related forecasts.
- Maintain current knowledge of commercial payor requirements and governmental reimbursement regulations and analyze their financial, contractual, reporting, and operational impact.
- Prepare and assemble financial and statistical reports required by governmental agencies, third-party payors, auditors, and external advisors.
- Coordinate and support third-party reimbursement and contract audits, respond to inquiries, assess proposed audit adjustments, and communicate material issues to leadership.
- Recommend and develop analyses and action plans for appeals, disputes, payment variances, and other matters involving third-party and governmental payors.
- Support contract and reimbursement quality assurance, audit readiness, internal controls, and compliance with established policies and procedures.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
