Senior Reimbursement Data Analyst

4 weeks ago

Springfield, United States Health New England Full time
Purpose

The Senior Reimbursement Data Analyst prepares the financial and statistical analysis related to in/out-of-network providers within the Health New England's service areas. As a member of the Finance team, the Senior Reimbursement Data Analyst is responsible for building, supporting and ensuring data integrity in support of contract modeling. The position will serve as a partner with the Contracting Department and other HNE organizational departments. As an individual contributor, the Senior Reimbursement Data Analyst will possess strong quantitative, technical, analytic and interpersonal skills.

Job Responsibilities
  • Supports the development and maintenance of tools for new and renewing provider reimbursement analysis through the use of internal membership, provider and claim databases
  • Assists in implementation of vendor software for repricing claims using CMS reimbursement methodologies
  • Subject matter expert and point person for ensuring updates to vendor software are implemented in modeling
  • Creates and supports competitive positioning and benchmarking analysis
  • Assists in measurement of provider cost and utilization performance for use in quarterly product pricing and annual budgeting/forecasting
  • Manages and enhances large technical financial and statistical databases working in conjunction with other departments and IT as necessary
  • Analyze and improve contracting value through identification and recommendations to create bundled reimbursements, from previous unbundled services
  • Extensive knowledge in ICD, CPT, HCPCS, 3rd party payer requirements, federal and state guidelines and regulations pertaining to coding and billing practices
  • Verifies and analyzes rate calculations submitted by hospitals and other providers for accuracy during the rate negotiation process
  • Stays abreast on the latest reimbursement principals, governmental regulations and requirements (CMS, etc.)
  • Responsible for the timely completion of external cost studies, prepares financial analysis filings and analysis on current and future reimbursement regulations
  • Performs ad-hoc analysis and other job related duties as required

A Bachelor's degree (MBA is preferred) in Finance, Accounting, Mathematics, Statistics, Actuarial, Data Science or related field.
  • Minimum of 5-7 years of progressive work experience in a health care analytics department setting (Healthcare Decision Support in managed care or hospital setting preferred)
  • Ability to recognize opportunities for innovation in reporting and work product
  • Ability to multi-task when faced with competing deadlines
  • Advanced technical skills with minimum of three years writing new SQL/SAS scripts and running existing scripts
  • Advanced Excel (pivot tables, V Lookups, macros etc.)
  • Displays positive customer focus and able to work independently with deadline orientation
  • Excellent analytical skills driven by a powerful inquisitiveness and curiosity about data
  • Experience with database and large data set usage; including reporting, management and manipulation for analytical purposes
  • Knowledge of healthcare financial analysis, trending, projections and analytic software models
  • Participates in continual learning related to CMS and Commercial reimbursement methodologies
  • Proficiency with innovating and developing new tools for end user's needs

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