Sr Financial & Data Analyst – Healthcare Economics

Wellmark, Inc.•Des Moines, IA

23h•Hybrid

About The Position

This role, also known internally as a Sr Network Economics Analyst, involves leading, designing, implementing, and maintaining provider reimbursement strategies. This includes financial reporting for all Wellmark-contracted providers and managing multi-year agreements. The position requires a deep understanding of contracting, claims payment procedures, and payment policy. Collaboration with Health Network team members is crucial for enhancing provider support. As a senior team member, you will mentor colleagues, act as a subject matter expert, and provide recommendations to leadership on strategic and payment policy decisions. The ideal candidate is a critical and strategic thinker, detail-oriented, analytical, and skilled in conceptual thinking and anticipating long-term outcomes. They should be adept at identifying and implementing continuous improvement opportunities in provider reimbursement, using advanced data analysis and a consultative approach to partner with internal business leaders. The ability to communicate insights from data effectively is essential, as is mentoring peers to enhance their analytical skills and knowledge of strategic provider reimbursement.

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.

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 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 the 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 that is 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.