Analyst Payer Analytics
Company: Dignity Health System Office
Location: Rancho Cordova
Posted on: May 16, 2022
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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.
[Facebook](https://www.facebook.com/CommonSpirit-Health-Careers-103069624573864)
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Responsibilities 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. 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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