Sr Analyst Payer Contracting

Nicklaus Children's • Miami, FL

8d

About The Position

The Sr Analyst Payer Contracting is responsible for financial modeling of Commercial Fee-for-Service, Value Based Managed Care, and Managed Medicaid initiatives. The role develops complex contractual financial analytics and models to support negotiations conducted by the Vice President of Population Health and Payer Strategy.

The analyst leads and performs analytics on Medicaid and value-based contract proposals, evaluates financial impact, and makes recommendations. The position supports managed care and Medicaid operations through automated reporting, reimbursement and contract analysis, budget development, payment auditing, and reporting enhancements. It also collaborates across teams and with external entities, supports negotiation workflows and presentation preparation, and helps improve efficiency through analytics, automation, and integration of relevant tools.

Requirements

• Bachelor's degree in Business Administration, Healthcare Administration, Finance, or a related field.
• Four to seven years of experience in business planning and analytics, including areas such as Medicaid, managed care contracting, payer analytics, strategic planning, business development, financial analysis, forecasting, and data modeling.
• Extensive experience using Business Intelligence systems.
• Advanced Excel modeling, formula, and automation skills.
• Ability to manipulate large data sets and transform them into usable, relevant information for strategic requests.
• Excellent verbal and written communication skills.
• Ability to maintain confidentiality of sensitive information.
• Ability to solve problems and formulate a plan of action.
• Ability to analyze and audit contracts, understand the broader context, 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 government and non-government payer healthcare reimbursement methodologies.
• Competency in financial and statistical reporting, including 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 that test or validate hypotheses.

Nice To Haves

• Master's degree in Business, Healthcare Administration, or a related field.
• Experience with FinThrive (previously known as 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 well-reasoned 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.
• Work 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 proper managed care contract loads and performance.
• Ensure rate updates are made accurately and on time.
• Develop 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 in the Managed Care negotiation workflow.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior