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Payer Strategy Analyst

3 months ago

Miami, Florida, United States Nicklaus Children's Health System Full time

Job Summary

Leads support for all governmental and non- governmental payer performance analytics, as well as other service line/operational/clinical/professional analytics, with the ability to utilize various software, systems, and other resources in order to meet or exceed Strategic objectives. Works cross functionally with internal teams, including but not limited to Finance, Decision Support, Global Health, Revenue Cycle, Patient Access, Nicklaus Children's Pediatric Specialists LLC, to ensure consistency and cross pollination of ideas and best practices in support of NCHS Pillars.

Job Specific Duties

  • Supports in the development and implementation of current, and future state, commercial and governmental payer analytics reports.
  • Demonstrates expertise and leadership in performing/producing intricate financial analysis utilizing a variety of analytics tools, including but not limited to spreadsheets, contract modeling systems, BI dashboards, decision support systems.
  • Serves as FinThrive subject matter expert by providing support/feedback to internal constituents on pricing estimator software utilized to produce self-pay and insured patient responsibility estimates, collaborating with the contract loading team to ensure appropriate interpretation/load of contractual rates, and reviewing/approving FinThrive access requests.
  • Possesses working knowledge of South Florida managed care payer environment, as well as commit to continuous learning and development of Statewide/National managed care payer trend in order to round out ability to produce well thought out, relevant and proactive analysis.
  • Supports managed care negotiations by ensuring timely and appropriate availability of all reporting and analytics to Director/VP.
  • Responsible for timely update and dissemination of a variety of departmental matrices, including but not limited to; payer hospital and employed physician rates/participation, charge master increases/notification, behavioral health rates/participation, DPP payment tracking, and telehealth policies.
  • Assists in yearly managed care budget analysis and preparation.
  • Reviews and disseminates monthly payer provider bulletins, as well as ad hoc payer communications, to appropriate internal staff.
  • Serves as the liaison with the Enterprise Business Intelligence team related to the implementation of Managed Care AI initiatives and innovations.