Sr Financial & Data Analyst – Healthcare Economics

Wellmark, Inc.•Des Moines, IA

7h•Hybrid

About The Position

This role, also known internally as a Sr Network Economics Analyst, involves leading, designing, implementing, and maintaining provider reimbursement strategies and financial reporting for Wellmark-contracted providers, including 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 to enhance provider support. As a senior team member, this role includes mentoring colleagues, serving as a subject matter expert, and making 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, anticipating long-term outcomes, and identifying continuous improvement opportunities in provider reimbursement. They should be adept at using advanced data analysis and a consultative approach to partner with internal business leaders and communicate insights from data effectively. The role also involves educating and mentoring peers. Hospital and/or health care facility reimbursement experience is preferred, as is experience with PowerBI, Tableau, SAS EG, and/or SQL. Candidates residing in the Des Moines, IA metro area are preferred. This position operates on a hybrid schedule, requiring at least three days per week in the Des Moines office (Tuesday-Thursday), with a remote option on Mondays and Fridays.

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 industry
Demonstrated experience performing financial analysis and data modeling in a healthcare setting
Solid knowledge of and demonstrated ability in Microsoft Excel (including superior ability in the use of Excel Macros, Advanced Formulas and Pivot Tables)
Previous experience in a healthcare, finance or related field, (i.e. hospital or physician office or experience in a position that supports the job specific competencies noted)
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
Strong analytical skills and proven problem solving ability with a proven record of independent problem identification and resolution skills
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

Nice To Haves

Hospital and/or health care facility reimbursement experience preferred.
Technical proficiency with tools, such as: Power BI, Tableau, SAS EG and/or SQL.
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.
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 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 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.