Analyst Payer Analytics
Company: Dignity Health System Office
Location: Rancho Cordova
Posted on: May 14, 2022
Job Description:
Overview
CommonSpirit Health is a nonprofit, Catholic health system
dedicated to advancing health for all people. It was created in
February 2019 through the alignment of Catholic Health Initiatives
and Dignity Health. CommonSpirit Health is committed to creating
healthier communities, delivering exceptional patient care, and
ensuring every person has access to quality health care. With its
national office in Chicago and a team of approximately 150,000
employees and 25,000 physicians and advanced practice clinicians,
CommonSpirit Health operates 137 hospitals and more than 700 care
sites across 21 states. In FY 2019, Catholic Health Initiatives and
Dignity Health had combined revenues of nearly $29 billion and
provided $4.45 billion in charity care, community benefit, and
unreimbursed government programs. - -
Responsibilities
Job Summary / PurposeThe 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. -
Qualifications
- 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! -#missioncritical#LI-DH
Keywords: Dignity Health System Office, Rancho Cordova , Analyst Payer Analytics, Professions , Rancho Cordova, California
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