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WVU Medicine · 1 month ago

Analyst Payment Modeling & Analysis, Value-Based Care - Hybrid

United States

Full-time

Hybrid

Entry, Mid Level

2+ years exp

WVU Medicine is part of the West Virginia University Health System, seeking a Payment Modeling and Strategic Analyst to shape financial strategies. The role focuses on analyzing healthcare claim data to support Payer Relations and Contracting, ultimately impacting the organization’s ability to provide affordable healthcare.

Health CareHospitalMedical

Responsibilities

Extracts data from various internal and external sources and conducts analysis of revenue for all third-party payer contracts and monitor existing effective payment percentages, in addition to modeling

Utilize data analysis tools and techniques to examine financial data, identify trends, and make data-driven recommendations for optimizing revenue streams and reducing costs

Performs data analysis and creates queries, programs and automation related changes in payer contracts or other programs affecting payment

Create financial models and forecasts to predict the financial impact of various payment and reimbursement scenarios, allowing the company to proactively adjust strategies

Provide support and create complex presentations, database and spreadsheets utilizing skills with various programs such as Excel, Access and PowerPoint

Leads data requirements gathering for problem identification, resolution, and solution design

Provides analytical insights from data to drive strategic business decisions

Analyze data from various sources and systems in order to present reports to key management and staff and to recommend and implement solutions to assist in the contracting decision making process

Develops and maintains Price Transparency files to comply with CMS regulation

Conduct market research to understand payment trends, healthcare regulations, and industry best practices, and use this knowledge to inform strategic decisions

Performs analysis and reporting to develop and maintain databases to track and trend incentive based reimbursement and investigate areas of improvement to ensure performance is in line with the organizational strategic plan

Develop strong relationship with accounting contacts and assist in completing and compiling financial support documentation for value-based external audits

Support development of the overall conceptualization, strategy alignment, and design of new value-based reimbursement models for PCPs, specialist, and hospitals

Develop a deep understanding and knowledge of market and governmental trends

Communicates to all parties the natures, significance and risk factors of corresponding projects

Participates in post implementation review of projects

Gathers customer requirements to understand business needs and translate into actionable solutions

Ensure that payment models and strategies comply with relevant healthcare regulations, coding guidelines, and industry standards

Works proactively and cooperatively in group problem-solving situations

Engages peers in improving the quality of the work

Qualification

Data analysisFinancial modelingHealthcare managementContract analysisMicrosoft ExcelTeam collaborationProblem-solvingCommunication skillsAdaptability

Required

Bachelor's degree in finance, accounting, economics, general business management, information technology/computer science, engineering, health care management or related field

Preferred

Familiarity with physician groups and hospitals preferred

Direct experience in data analysis, financial analysis and reporting

Exposure and/or experience in health care management, related contracting field, health care insurance services/industry, hospital finance and/or healthcare consulting preferred

Master's Degree in a related field or two (2) years of related work experience