Sr Financial & Data Analyst – Healthcare Economics

Wellmark•Des Moines, IA

2d•Hybrid

About The Position

This role, also known internally as a Sr Network Economics Analyst, will lead, design, implement, and maintain provider reimbursement strategies, including financial reporting for all Wellmark-contracted providers and multi-year agreements. This involves leading provider reimbursement initiatives by applying a thorough understanding of contracting, claims payment procedures, and payment policy. Collaboration is key, requiring the building and maintenance of strong business relationships with other Health Network team members at Wellmark to enhance support for providers. As a Senior-level team member, you will mentor team members, serve as the subject matter expert, and make recommendations to leadership on strategic and payment policy decisions. The ideal candidate is a critical and strategic thinker, detail-oriented, and analytical, skilled in conceptual thinking, anticipating long-term outcomes, and identifying continuous improvement opportunities around provider reimbursement. They should enjoy using advanced data analysis experience and a consultative nature to make recommendations and partner with internal business leaders, and be skilled in creating and communicating insights from data. Additionally, they should enjoy educating and mentoring peers to build their analytical skills and strategic provider reimbursement knowledge. Hospital and/or health care facility reimbursement experience is preferred. Candidates residing in the Des Moines, IA metro area are preferred. This position will work a hybrid schedule of at least 3 days in Wellmark's Des Moines office (Tuesday-Thursday), with Monday & Friday remote options.

Requirements

Bachelor's degree in accounting, finance, business, economics or related field or direct and applicable work experience.
7+ years of relatable experience within the health insurance, healthcare or related financial industry experience including demonstrated experience performing financial analysis and data modeling preferably in a healthcare setting.
Solid knowledge of and demonstrated ability in Microsoft Excel along with technical proficiency with tools such as Power BI, Tableau, SAS EG and/or SQL.
Knowledge of hospital, physician and other provider payment and contracting strategies.
Demonstrated knowledge of the health insurance industry including delivery systems and managed care concepts; thorough understanding of reimbursement, contracting, claims processing, medical policies.
Experience interpreting claims data, trends and provider utilization in order to determine payment strategy or payment strategy results.
Demonstrated forethought of issues before questioned; ability to research, ask questions and find solutions to potential problems.
Demonstrated problem-solving, quantitative and analytical skills; ability to recognize inconsistencies, analyze for reasonableness and accuracy, research and come to conclusions.
Comprehensive knowledge of nationally recognized provider compensation strategies.
Strong attention to detail (timeframes, resources, parties involved, communication, etc.) in developing and implementing action plans.
Demonstrated ability applying strong analytical, conceptual and strategic thinking skills to negotiate with providers, or the organizations representing them.
Ability to serve as subject matter expert to mentor team members.
Strong presentation skills and the ability to clearly articulate recommendations to business leadership to achieve business results.

Nice To Haves

Hospital and/or health care facility reimbursement experience preferred.
Candidates currently residing in the Des Moines, IA metro area preferred.
Proficiency in HROR highly preferred.

Responsibilities

Lead, design, implement, and maintain provider reimbursement strategies, including financial reporting for all providers.
Research, document, monitor, and implement provider reimbursement related activity and initiatives.
Perform advanced data analysis and insight in support of provider reimbursement initiatives.
Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations as appropriate.
Consult with and provide subject matter expertise to Network Economics, Health Network, and other Wellmark business stakeholders in recommendations and enhancements to provider payment strategies and payment policy decisions.
Serve as consultant in collaboration with Network Engagement to provide reimbursement guidance/expertise and payment policies to providers and applicable stakeholders.
Configure, transfer, and monitor data being processed in the provider payment systems.
Collaborate with testing and system implementations and enhancements.
Provide business knowledge and payment processing expertise in projects, if applicable.
Collaborate, interface, and manage all service level agreements and management of the relationship with all provider payment vendors.
Other duties as assigned.