Payor Contract Reimbursement Analyst - Payor Contracting - Day
About the position Responsibilities • Prepares and analyzes various data reports in support of payor negotiation for all System entities. • Prepares and analyzes the financial impact for specialty services, specialty pricing/bundles, and entities such as Hospitals and Medical Groups. • Prepares, analyzes, and maintains payor performance reports/yield and payor scoring reports for all System entities and identifies opportunities for improvement. • Develops predictive modeling in support of payor negotiation for all System entities. • Prepares annual budget forecasting and modeling support for all System entities. • Supports System compliance with contract notification terms, such as annual price increases and changes in service. • Prepares analysis for unique reimbursement methodologies for specialized payor contracts in conjunction with the Vice President of Payor Contracting & Population Health. • Supports professional and collaborative relationships with Payors and team members. • Provides ad-hoc financial and negotiation analysis and reports to System management as requested. • Analyzes financial impact of contract reimbursement, policy, or language changes/initiatives in conjunction with operational staff. • Assures that proposed, new and/or changed contractual programs are attainable within the organization and accurately memorialize the agreed upon terms. • Maintains knowledge of industry accepted contractual arrangements, financial opportunities, operational challenges, and other payor initiatives. • Participates in the strategic improvement of payor contracts as part of the Contract Integration Team. • Analyzes performance programs such as Arches, Foundations, and bundle payment opportunities. • Validates and reconciles payor reporting, Cost and Utilization reporting, and internal dashboards. • Utilizes Behavioral Health and Pharmacy Analytics to support negotiations. • Assists with reporting requests for all Deloitte model updates. • Performs proactive operational payor reporting - payor policy impacts via financial analytics tools. • Supports, updates, and maintains Payor Scorecard and Competitive Pricing Tool. Requirements • Associates Degree Required; Bachelor's Degree in Finance, Accounting, Management, and/or Health Care Administration Preferred. • 3 years of working knowledge of Health System Revenue Cycle operations and payment methodologies. • 3 years of healthcare reimbursement, third party payor negotiation/operations or regulatory experience, EPIC reporting, Power BI Preferred. • Advanced Excel Skills (Pivot Tables, Advanced Formulas). • Critical thinking skills. Nice-to-haves • Experience in healthcare reimbursement and third-party payor negotiation/operations. • Knowledge of regulatory experience and EPIC reporting. Benefits • Comprehensive health benefits • Flexible spending and health savings accounts • Retirement savings plan • Paid time off (PTO) • Short-term disability • Education assistance • Financial education and support, including DailyPay • Wellness and Wellbeing programs • Caregiver support via Wellthy • Childcare referral service via Wellthy Apply tot his job Apply tot his job