Baystate Health · 8 hours ago
Sr. Provider Network Analyst
Springfield, Massachusetts
Full-time
Onsite
Mid, Senior Level
$81K/yr - $111K/yr
3+ years expBaystate Health is a healthcare organization seeking a Sr. Provider Network Analyst to develop and present analytics for the Contracting department's strategies. The role involves financial analysis, report development, and collaboration across departments to support provider reimbursement strategies and operational needs.
DeliveryFitnessHealth CareHospitalMedical DeviceStaffing Agency
Responsibilities
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
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
Qualification
Required
Bachelor's degree required
Three to five (3 to 5) years of similar experience
Minimum of two (2) years of health care experience
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
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
Preferred
Experience in Provider Network Management preferred
Previous experience in data analysis and reporting using SAS / SQL, Python, Excel, and Access preferred
Company
Baystate Health
Baystate Health is an integrated health care delivery system serving a population of nearly one million people in western Massachusetts.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$3.9MKey Investors
Massachusetts Life Sciences Center
2023-10-04Acquired
2019-06-03Grant· $3.9M
Leadership Team
Peter D. Banko
CEO
Marion Mcgowan
Executive Vice President | Chief Operating Officer
Recent News
2026-01-14
2025-11-05
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