Healthcare Modeling Analyst Payment Transformation
Company: Dignity Health
Location: Rancho Cordova
Posted on: November 24, 2022
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
- Conduct modeling of proposed/existing VBAs negotiated by Payer
Strategy and Relationships, including expected and actual
revenues/volumes, past performance, proposed contract language and
- 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
- Maintain knowledge of operational finance, business accounting,
payer policies, and legal/compliance requirements to identify
causative factors, deviation, or casualties that may affect
- 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
- Must be able to lead and coordinate projects through various
complex and challenging situations to completion under
- 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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