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CommonSpirit Health · 23 hours ago

Senior Analyst Payer Analytics and Economics

United States

Full-time

Remote

Mid, Senior Level

$37.22/hr - $55.37/hr

3+ years exp

CommonSpirit Health is a healthcare organization focused on providing support and resources to local communities. The Senior Analyst, Payer Economics will perform complex financial analysis and strategic pricing for managed care contracts, while also providing mentorship and guidance to stakeholders in the process.

Health CareMedicalNon Profit

Responsibilities

Lead payer contract modeling strategy and consolidation for large managed care payer negotiations. Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement

Perform complex 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

Monitor contract financial performance

Analyze and publish managed care performance statements and determine profitability

Review and accurately interpret contract terms, including payer policies and procedures impacting 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

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, provision, parameters and rate structures aimed at establishing appropriate reimbursement levels

Identify, collect, and manipulate from a wide variety of financial and clinical internal databases and external sources

Identify and access appropriate data resources to support analyses and recommendations

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

Qualification

SQLVBAExcelFinancial analysisHealthcare reimbursementData managementFinancial statementsSoft skills

Required

Bachelor's Degree in Business Administration, Accounting, Finance, Healthcare or related field. Equivalent education and experience in a related field may be considered in lieu of degree

Minimum of three (3) years of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service provider reimbursement methodologies

Working knowledge of financial healthcare reimbursement analysis including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies

Experience in contribution 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 MS Excel, MS Access, MS Visual Basic, PIC, SQL, or other related applications

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, PIC, SQL Databases, etc.)

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

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