Sr. Provider Network Analyst

Baystate Health•Springfield, MA

6h•$81,432 - $110,718

About The Position

Summary: The Sr. Provider Network Analyst will be responsible for the development and presentation of analytics related to support of the Contracting department’s strategies, including benchmarking of market cost and utilization trends and patterns. Will have strong leadership ability to create analytical models and lead technical design with data integrity and efficiency as guiding principles. Provides decision support to the Contracting and Finance leadership. Leads development of provider reimbursement analysis and models (involving multiple variables and assumptions) to support a variety of reimbursement strategies, approaches, and provisions. The Sr. Provider Network Analyst serves as a primary contact and content creator for provider network financial data, for purposes including but not limited to existing provider contractual relationships, proposed provider or vendor contracts, renegotiation of physician, hospital, or ancillary provider contracts, and ad hoc reporting and analytic models to support Provider Network strategy and operations. This role requires a combination of technical skills in data analysis, a broad understanding of health plan functions and provider claims, and the business acumen to understand financial concepts. This role is required to translate contract provisions into financial models, identify opportunities and challenges associated with HNE’s Total Medical Expense, and perform other analyses as required by the VP of Provider Network Strategy & Management or their designee. The Sr. Provider Network Analyst is a senior-level individual contributor role and reports to the VP, Provider Network Management.

Requirements

Bachelor's degree required
Three to five (3 to 5) years of similar experience
Minimum of two (2) years of health care experience
Experience with allocations and ratios, product mix, and risk adjustment concepts
Experience with SQL and/or SAS. Ability to write and run complex queries is required for this position.
Analytical and detail-oriented, Audit-minded thought process

Nice To Haves

Experience in Provider Network Management preferred
Previous experience in data analysis and reporting using SAS / SQL, Python, Excel, and Access preferred
Effective at managing competing priorities and can work independently with little oversight. Ideal candidate will be self-motivated and self-starting
Strong analysis, critical thinking, and troubleshooting skills
Strong knowledge of Managed Care lines of business including Commercial, Medicaid, and Medicare Advantage
Significant experience with data interpretation, analysis and reporting using a variety of analytic tools.
Experience with both financial and clinical data, and with the complexities of models for various types of provider payment methodologies, Quality Improvement metrics, and value based risk contracts

Responsibilities

Financial Analysis and Report Development Performs ongoing market analysis using benchmarking across HNE network providers using a standard CMS approach with various types of reimbursement methodologies (DRG, RVUs, ASC, OPPS, AWP & ASP etc.)
Leverages relationships and collaboration across multiple HNE departments to build a high level of trust and collaboration in report development, analysis, and timely delivery
Interprets financial, accounting, and contractual information to ensure accuracy of data used in reporting, analysis, contract modeling, and forecasting
Utilizes software including Amisys, Microsoft (Access, Excel, SQL Server) and/or SAS to perform queries utilizing the data warehouse, to refresh financial models by line of business, individual provider negotiation models, and/or other ad hoc reporting
Resource for other members of the department/division on data-based business processes and may be responsible for training and guidance of other associates
Presents data driven financial information and succinctly communicates analytic results to internal and external stakeholders
Evaluates and researches departmental data needs by engaging stakeholders and identifying inefficiencies/waste, risks, and key person dependencies
Identifies areas of opportunity to further enhance financial processes and data mining to better align with the corporate-wide strategy of Caring, Simplification, and Affordability
Identifies major cost drivers and recommends strategies for mitigating the cost drivers
Continuous education in federal, state, and industry reimbursement and analytic models
Additional Analysis and Support Duties Works in partnership with multiple business areas to create comprehensive documentation (SOPs), training, and identify key dependencies and needs for Provider Network planning, strategy, and operations.
Generates reports used to analyze network adequacy, perform gap analysis, and support design & construction of optimally-sized networks meeting all state and federal regulatory requirements
Communicates to stakeholders and leadership on project status, outcomes, and improvements
Provides ad-hoc reporting and analysis for financial, governmental, pharmacy, and administrative data used in strategic decision-making
Understanding and competency with Quest Analytics for network adequacy and accessibility analysis reporting
Familiarity with the Massachusetts All Claims Payer Database and ability to retrieve strategic data from this database and other external reference sources
Performs sensitivity analysis to identify risk/exposure associated with payment changes