Payer Contracting Analyst

3 weeks ago

Chicago, United States The University of Chicago Medicine Full time

**Job Description**:
Be a part of a world-class academic healthcare system at **UChicago Medicine** as a** Contracting Risk Analyst - Value Based Care** **for the **Finance Managed Care **department.This position is a hybrid remote opportunity with occasional requirements to come in off at our **Burr Ridge or Hyde Park **locations.

**Essential Job Functions**:

- Perform sophisticated VBC risk analyses including developing contractual risk models, financial and operational models and performance monitoring and evaluations. Responsible for VBC and CIN risk corridor and feasibility analysis, financial forecasts of upside/downside risk, determination of Stop-Loss, among other risk based contract terms. Creates financial models and forecasts that provide insight on mitigating potential losses and maximizing and optimizing financial performance under VBC contracts. Develops models for projecting and evaluating costs trends in risk contracts across enterprise. Supports development and maintenance of physician incentive models and payout distribution methodologies. Sources large integrated internal databases (Enterprise Data Warehouse, vendor sources data marts, etc) to develop analyses. Analyzes complex datasets to assess changes and opportunities in total cost of care, leakage and membership attribution.
- Work closely with the VP Payer Contracting and Director Value Based Payment Models to support all VBC contract negotiations for Managed Care Commercial payers, Direct-To-Employer, Medicare Advantage payers and Medicaid payers to analyze, model and negotiate VBC contract risk terms for UCM hospitals and physicians. This includes assessment and identification of contract opportunities through implementation of the contract; negotiating and managing complex and innovative VBC risk methodologies striving to maximize performance and incentive opportunities.
- Works with OMC and CIN teams on monitoring of current internal performance and analysis of VBC risk contracts by creating standard internal reporting that monitors current performance and forecasts future trends. Partners with internal and external department analysts on developing physician incentive reporting, as well as custom reporting that analyzes data for trends analysis and interpreting medical patterns to uncover opportunities in risk performance. Supports subcommittee report outs on active risk-based programs.
- Create reports of contract outputs, historical trends, and opportunity analyses as needed for OMC, CIN, and senior leadership.
- Continued education on ever-changing VBC program rules and policy updates both commercial and governmental that impact expected performance contract profiles and education of internal stakeholders on risk and performance terms, methodology and impacts as needed.

**Required Qualifications**:
- A Bachelor’s degree in Business, Finance, Healthcare, or related field, or a combination of relevant education and experience. Advanced Degree in Finance based disciplines are preferred.
- Five or more years of experience in a multi-facility health system in either: Prior experience with value-based care (VBC)/alternative payment models
- Five or more years’ experience in multi-facility health system, large academic and community physician groups or clinically integrated network, large academic medical center or insurer environment.
- Experience in the following areas highly desirable:

- Risk programs analysis and reporting - including Medicare Advantage, Bundled Payments, and ACOs.
- Experience in supporting risk based contract negotiations.
- Experience with Health system data warehouses and datamarts.
- Knowledge and experience in VBC provider incentive distribution managementprograms and incentive funds flow preferred.
- Payer experience preferred
- Requires detailed knowledge of hospital and physician complex value based care (VBC) risk reimbursement methodologies including shared savings, capitation, downside risk, % of premium, global risk and bundled payments.
- Experience with CMS CMMI governmental programs related to Medicare and Medicaid highly desirable.
- Requires detailed knowledge of hospital and physician complex VBC methodologies, particularly Value based care (VBC) risk reimbursement structure knowledge.
- Excellent understanding of risk based contracts, including:

- Proficient understanding of MSSP and Medicare Advantage contracting methodologies, upside/downside risk corridors, Stop-Loss provisions, financial effect of risk capture, among others.
- Proficient understanding of payer claims files and file formats, including Revenue Code and CPT coding in a clinical/hospital/ASC/physician office setting.
- Proficient manage care contract rate interpretation skills
- Demonstrated advanced technical skill and knowledge of healthcare EDW data systems and query languages.
- Experience in population health and value based care data repositories, third party software tools, and working with payer claims datas

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