Strategic Healthcare Contract Analyst
3 weeks ago
Job Summary
We are seeking an experienced and analytical professional to join our Digital & Analytics team as a Provider Contract & Network Underwriting Lead Analyst. In this role, you will be responsible for conducting hospital and professional provider contract underwriting/analysis, partnering with Contracting to deliver unit cost results in line with trend/cost expectations.
About the Role
- Analyze the impact of proposed terms on profitability, trend, and other metrics.
- Leverage competitor data and insights in contract negotiation modeling.
- Effectively influence contracting in a strategic fashion and offer meaningful options during negotiations with providers.
- Provide ad hoc analysis and deep dives into data as appropriate to support negotiation and provide value to contracting partners.
- Summarize and explain findings and recommendations.
- Proactively identify opportunities for trend reduction and engage contracting to build these into plans where appropriate.
- Maintain accurate records and communicate progress to management.
- Collaborate with matrix partners to validate and adopt new tools and models.
Requirements
- 3+ years' experience in analyzing medical claims experience in TMC and/or Contract Underwriting for Fee for Service and Fee for Value contracts.
- Knowledge of standard medical coding: CPT, ICD10, HCPC ideal.
- Proficiency with Excel to perform data mining and reporting functions; familiarity with Access is preferred.
- Strong analytical and problem-solving skills with ability to independently perform analyses and apply statistical models.
- Understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, and utilization management.
- Excellent communication skills to include written, oral, and group presentation.
- Able to work independently while managing multiple tasks and meeting deadlines.
- Bachelor's degree in Finance, Economics, Business, Health Policy Analysis, Healthcare Administration, Mathematics, or Statistics preferred.
Estimated Salary
$120,000 - $150,000 per year, based on location and experience.
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