Sr Analyst Payer Contracting

Nicklaus Children's Hospital•Miami, FL

About The Position

The Sr Analyst Payer Contracting is responsible for financial modeling for Commercial fee-for-service (FFS), value-based managed care, and Managed Medicaid initiatives. The role develops complex contractual financial analytics and models used in negotiations conducted by the Vice President of Population Health and Payer Strategy. The analyst evaluates contract proposals, supports negotiations, creates and maintains automated reporting, and provides financial and operational analysis to guide reimbursement strategy. The position works cross-functionally with Ensemble partners and supports programs, pricing, reporting, contract administration, and related EPIC work.

Requirements

Bachelor's degree in Business Administration, Healthcare Administration, Finance, or a related field.
4–7 years of experience in business planning and analytics, such as Medicaid, managed care contracting, payer analytics, strategic planning, business development, financial analysis, forecasting, or data modeling.
Extensive experience using Business Intelligence systems.
Advanced Excel modeling, formulas, and automation skills.
Ability to manipulate large data sets and transform them into usable, relevant information in support of strategic requests.
Excellent verbal and written communication skills.
Ability to maintain confidentiality of sensitive information.
Ability to problem-solve and formulate a plan of action.
Ability to analyze and audit contracts, understand the big picture, and identify appropriate areas to model and assess financial impact.
Strong ability to multitask and pivot as needed.
Ability to execute and follow through on tasks.
Knowledge of reimbursement terminology and contract testing.
Knowledge of payer healthcare reimbursement methodologies, including government and non-government payers.
Competency in financial and statistical reporting and in designing and preparing spreadsheets and other financial reports.
Strong problem-solving skills and openness and adaptability to constructive criticism.
Ability to work in a high-pressure, deadline-driven environment.
Strong attention to detail and ability to connect overarching strategy to detailed analytical approaches for testing hypotheses.

Nice To Haves

Master's degree in Business, Healthcare Administration, or a related field.
Experience with FinThrive (formerly MedAssets) or a similar contract management tool system.
Experience working with EPIC.

Responsibilities

Perform and lead complex analytics on Medicaid and value-based contract proposals, evaluate financial impact, and make logical recommendations.
Support contract negotiations with financial analysis connecting complex, multidisciplinary concepts that affect reimbursement.
Maintain, create, and implement automated reporting to manage Medicaid, Managed Care, and value-based business, including proactive trending and impact analysis using key metrics and statistics.
Maintain awareness of Managed Care and Medicaid industry initiatives that affect funding and reimbursement to children's hospitals.
Provide analytics support for DPP and PSPP programs, working with outside entities and consultants as needed to develop analytics packages and reporting.
Develop and perform in-depth analytics using various tools and recommend streamlining and automation to improve efficiency.
Support preparation of JOC and MOR presentations.
Work cross-functionally with Ensemble partners to ensure appropriate managed care contract loads and performance, timely and accurate rate updates, and reporting to audit expected payment calculations and identify contractual rate areas requiring attention.
Lead development of the annual managed care net revenue budget package.
Develop and enhance managed care volume and net revenue trend analysis reporting to provide leadership timely access to relevant information.
Support Care Pricer estimator issues, transparency data needs, insurance plan code master changes, and EPIC-related items.
Develop, enhance, and support Global package pricing.
Increase utilization and integration of the Turquoise price transparency tool into the Managed Care negotiation workflow.