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Healthcare Modeling Analyst Payment Transformation

Company: Dignity Health
Location: Rancho Cordova
Posted on: November 24, 2022

Job Description:

Overview
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. Responsibilities
Job Summary The Senior Analyst, Payment Transformation provides financial pricing performance analysis for CommonSpirit Health (CSH) providers. Develops performance analysis for value-based agreements (VBA) and initiatives. Develops strategies for maximizing reimbursement and market share from value-based programs and payment models. Monitors VBA participation and performance across the system using standardized tracking and reporting tools. Provides VBA related education to key stakeholders.

This position will serve and support stakeholders through ongoing education and problem-solving support for value-based arrangements. - 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 take accountability for designated reimbursement and accounting systems and must be proficient in reading, interpreting, and formulating complex computer systems programming/rules.
Essential Key Job Responsibilities

  • Monitor contract utilization, population risk, and financial performance of value-based agreements (VBAs) including capitation.
  • Conduct modeling of proposed/existing VBAs negotiated by Payer Strategy and Relationships, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
  • Analyze and publish VBA performance statements and/or presentations and determine opportunities for performance improvement. Review and accurately interpret VBA contract terms, including development of policies and procedures in support of VBA negotiation and implementation.
  • Analyze terms of new and existing risk and non-risk VBAs and/or amendments/modifications using approved model contract language and following established negotiation procedures.
  • Act as the Payer Strategy & Relationships liaison across CommonSpirit Health for tracking, reporting, updating and communicating VBA participation and performance information.
  • Support the negotiation and implementation of appropriate capitation and other VBA reimbursement rates and associated language between physicians/hospitals and payers/networks in value-based contracting initiatives. Develop financial models and inform VBA negotiation procedures.
  • Prepare complex service line reimbursement analyses and financial performance analyses (involving multiple variables and assumptions) to identify the implications and results of a wide variety of new/revised VBA strategies, approaches, provisions parameters, and rate structures aimed at establishing appropriate reimbursement methodologies and pricing levels.
  • Identify collect, and manipulate data from a wide variety of financial clinical internal databases (e.g., Star, TSI, PCON, EPIC, DHMSO, BIDS, HBI) and external sources (e.g., Medicare/Medicaid website) to develop analytics pertaining to VBA arrangements, including but not limited to, identifying risk/exposure with various reimbursement structure options, statistical reports on populations or new ventures, or sensitivity analyses on multivariable revenue models.
  • Prepare and effectively present analytic or project results to leadership, and other key stakeholders, for review and decision-making.
  • Maintain knowledge of operational finance, business accounting, payer policies, and legal/compliance requirements to identify causative factors, deviation, or casualties that may affect reporting conclusion.
  • Serve and support all stakeholders through on-going education, problem-solving, ad-hoc reporting, and general support for value-based contract analytics and program management.
  • Accountable for utilizing designed payer and accounting systems for report visualization preparation or data transfers within the course of business to optimize financial performance under various financial arrangements. Qualifications
    • 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 five (5) years' experience in Healthcare analytics or related analytics field
    • Must have strong experience in billing and claims data.
    • Managed Care / Payer knowledge preferred.
    • Intermediate level working knowledge of SQL and Excel.
    • Basic knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation.
    • Must be able to lead and coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines.
    • Strongly preferred working knowledge of healthcare financial statements or accounting principles.
    • Ability to use and create data reports from health information systems, databases, or national payer websites (EPIC, PESI, PIC, SQL Databases, NextGen, CMS.Gov, etc.)
    • Strong background in financial healthcare reimbursement analysis is required, including an understanding of national standards for value-based provided reimbursement methodologies. A compensation range of $66,000 - $95,000 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! #LI-DH #missioncritical

Keywords: Dignity Health, Rancho Cordova , Healthcare Modeling Analyst Payment Transformation, Professions , Rancho Cordova, California

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