Analyst Payer Analytics
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Job Summary / Purpose
The Analyst, Payer Analytics & Economics performs complex 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 mentorship and guidance of Analyst contract modeling. 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 Job 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 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 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.
- Provides leadership, oversight and training for Payer Analytics & Analyst contract modeling activities.
- Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare or related field. Equivalent education and experience, in related field 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.
- 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.
A compensation range of $66,000 - $80,000 is the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more!
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