Job Description

Job Summary/Purpose:

The Analyst, Payer Analytics & Economics performs managed care payer financial analysis, strategic pricing and payer contract modeling activities for a defined payer portfolio. Provides analytical and pricing expertise for the evaluation, negotiation, implementation and maintenance of managed care contracts between CommonSpirit Health providers and payers. Recommends strategies for maximizing reimbursement and market share. Provides analysis findings and education to key stakeholders.
This position will serve and support all stakeholders through ongoing educational and problem-solving support for managed care payer reimbursement models. This position requires daily contact with senior management, physicians, hospital staff, and managed care/payer strategy leaders.

Essential Key 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 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 stakeholder training of the modeling of proposed/existing negotiated payer contracts, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
? Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement.
? Prepare 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 data bases (e.g. PIC, STAR, TSI, PCON, EPIC) and external sources. Identify and access appropriate data resources to support analyses and recommendations.
? Prepare and effectively present results to 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.

Qualifications

MINIMUM QUALIFICATIONS

Required Education and Experience

? Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare or related field. Equivalent education and/or experience may be considered in lieu of degree.
? Minimum of one (1) year 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.

Required Minimum Knowledge,

Skills, Abilities and Training

? Experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and value-based provide 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, EPSI, PIC, SQL Databases, etc.)
? Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas.

~LI-DH

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