Payer Analytics Economics Analyst
The Analyst, Payer Analytics & Economics performs managed care financial analysis, strategic pricing and payer contract modeling activities for a defined payer portfolio for the physician enterprise. 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. Develops new managed care products with external payers that are consistent with approved strategic plans. Provides education to key stakeholders. Leads special projects for the senior leadership as requested.
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. The position must handle adverse and politically difficult situations, as the work may have a direct impact on individual physician incomes, along with directly impacting the financial performance of CommonSpirit Health. This role must be proficient in reading, interpreting, and formulating complex computer system programming/rules.
- 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
- 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.
- Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare
or related field required or equivalent experience
- Experience in healthcare reimbursement analysis or similar is required,
including an understanding of national standards for fee-for-service
- Preferred understanding of 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
- Proficiency in MS Excel
- Basic understanding in one or more of the following systems preferred: SQL, Oracle, MS Access, MS
Visual Basic, C++, SAS or other related applications.
- Basic knowledge of physician fee-for-service reimbursement methodologies.
Working knowledge of healthcare financial statements and accounting
- 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
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CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.
CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.