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CommonSpirit Health · 1 day ago

Senior Analyst Payer Analytics and Economics

United States

Full-time

Remote

Mid, Senior Level

$35.10/hr - $53/hr

2+ years exp

CommonSpirit Health is one of the nation’s largest nonprofit Catholic healthcare organizations, delivering integrated health services. The Senior Analyst, Payer Analytics & Economics is responsible for financial analysis, strategic pricing, and payer contract modeling to maximize reimbursement and market share for managed care contracts.

Health CareMedicalNon Profit

Responsibilities

Perform strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives. Develop and approve financial models and payer performance analysis

Assure satisfactory contract financial performance. Analyze and publish managed care performance statements and determine profitability. Drive strategies and solutions in order to maximize reimbursement and market share, which have multi-million or multi-billion dollar impact to CommonSpirit Health. Review and accurately interpret contract terms, including development of policies and procedures in support of contract performance

Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes

Analyze terms of new and existing risk and non-risk contracts and/or amendments/modifications using approved model contract language and following established negotiation procedures

Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement

Prepare complex service line reimbursement analyses and financial performance analyses

Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provisions, parameters and rate structures aimed at establishing appropriate reimbursement levels

Identify, collect, and manipulate from a wide variety of financial and clinical internal data bases (e.g. PIC, Star, TSI, PCON, Epic) and external sources (e.g.; Medicare/Medicaid/Payer websites). Identify and access appropriate data resources to support analyses and recommendations. Identify risk/exposure associated with various reimbursement structure options. Gather date and produces analytical statistical reports on new ventures, products, services on operating and underlying assumptions such as modifications of charge rates

Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities

Maintain knowledge of operations sufficient to identify causative factors, deviations, allowances that may affect reporting findings. Ability to translate operational knowledge to identify unusual circumstances, trends, or activity and project the related impact on a timely, pre-emptive basis

Manage adverse and politically difficult situations, as the work may have a direct impact the financial performance of CommonSpirit Health

Other duties as assigned by management

Qualification

Financial healthcare analysisReimbursement methodologiesSQL proficiencyData management strategiesHealthcare financial statementsManaged care knowledgeAnalytical skillsPresentation skills

Required

Bachelor's Degree in Business Administration, Accounting, Finance, Healthcare or related field required or equivalent experience

2+ years of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies

Experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations

Basic technical understanding and proficiency in SQL, MS Excel, or other related applications

Solid knowledge of fee-for-service reimbursement methodologies

Working knowledge of healthcare financial statements and accounting principles

Ability to use and create data reports from health information systems, databases, or national payer websites (Epic, EPSI, PIC, SQL Databases, etc.)

Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas

Preferred

Managed care knowledge/experience preferred

Company

CommonSpirit Health

Glassdoor3.6

Common Spirit Health is a healthcare organization that provides research programs, home health programs, and virtual care services. It is a sub-organization of CommonSpirit Health.

Founded in 2019

Chicago, Illinois, USA

10001+ employees