Healthcare Reimbursement Analyst
7 days ago
Overview of CommonSpirit Health
CommonSpirit Health is a leading healthcare provider in the US, formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With over 700 care sites across the country, our organization is accessible to nearly one out of every four US residents. Our mission is to build healthy communities, advocate for those who are poor and vulnerable, and innovate how and where healing can happen.
Job Summary / Purpose
The Analyst, Payer Analytics & Economics performs complex managed care payer financial analysis, strategic pricing, and payer contract modeling activities for a defined payer portfolio. This role provides analytical and pricing expertise for the evaluation, negotiation, implementation, and maintenance of managed care contracts between CommonSpirit Health providers and payers. The ideal candidate will have a strong understanding of national standards for fee-for-service and value-based provider reimbursement methodologies.
This position requires daily contact with senior management, physicians, hospital staff, and managed care/payer strategy leaders. The resources within Payer Analytics & Economics (PAE) that focus on Revenue Integration & Defense will be accountable for the integration of payer analytics and expected reimbursement calculations within system-wide operational tools and processes developed to support price transparency requirements, No Surprises Act readiness, payer policy disputes, and other key system initiatives to analyze and defend our in-network and out-of-network payer revenue.
Key Responsibilities
The Analyst, Payer Analytics & Economics will be responsible for:
* Evaluating and enhancing the various ways our expected reimbursement calculations from Payment Integrity Compass are integrated within system-wide initiatives to defend our in and out-of-network payer revenue.
* Developing reporting to identify, and potentially correct, systematic expected reimbursement modeling variances impacting downstream stakeholders (such as Completeness and Accuracy and Calculation Error reporting)
* Supporting downstream users of expected reimbursement information across the organization within the areas of payer disputes, price transparency requirements, No Surprises Act initiatives, revenue analytics, etc
* Reviewing and analyzing payer policy impact and collaborating on internal communication and education as applicable to prevent adverse impact from payer policy changes
* Assisting with research and education for PAE on the impact of various legislative issues and billing, payer, and healthcare industry topics as needed.
Qualifications
The ideal candidate will have a Bachelor's Degree in Business Administration, Accounting, Finance, Healthcare, or a related field. Minimum of one (1) year of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies. Experience in contribution to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations is also required. Strong MS Excel skills are essential, and proficiency in SQL queries, MS Visual Basic, PIC, or other related applications is strongly desired.
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