Provider Contract & Reimbursement Analyst-Intermediate

About the role

The Provider Contracting & Reimbursement Analyst-Intermediate will analyze utilization, claims, membership, and cost data in support of the Network Contract Management department and corporate strategic initiatives. They will design and use analytical tools to draw statistically sound conclusions and present results to management. The Analyst will interpret, analyze, and recommend courses of action to management as it relates to fair, equitable, and market competitive reimbursement designed to achieve value for the health plan, provider partners, and members. They will design and conduct analyses by applying independent judgment (e.g., making assumptions and identifying constraints of analyses), interpreting results, and making recommendations to management as it relates to assessing the impact of changes in reimbursement and representing hundreds of millions of dollars in annual expenditure. Analysis and research will be designed to support provider contract negotiations, assess the impact of potential alternative reimbursement models, improve Independent Health's ability to deliver high quality high value care, and provide management with the ability to assess the impact of policy changes, government mandates, consolidations, and mergers in the provider community.

Requirements

• Bachelor's degree required. MBA or equivalent advanced degree preferred. An additional four (4) years of experience will be considered in lieu of degree.
• Three (3) years of analytics experience OR an advanced degree plus two years of experience (research/internship experience qualifies) required.
• Experience in data analysis, statistical analysis, business modeling or health care analytics/health informatics preferred.
• Highly proficient in Access, Excel, and other analytical tools/programs (e.g., SQL, SAS, Microsoft Fabric).
• Strong understanding of the health care industry, health care economics, hospital, physician, and ancillary reimbursement methodologies preferred.
• Skilled in statistical concepts, methodologies, and applications related to health care analytics and provider network management.
• Ability to frame questions that create value for business partners.
• Extensive experience in building and using statistically sound data modeling support tools to conduct trend analysis and determine cost and utilization drivers.
• Ability to define problems, collect data, establish facts, draw conclusions, transform data into actionable information and clearly present results to upper management.
• Attention to detail and skilled at data validation methodologies.
• Ability to work collaboratively with other departments.
• Excellent verbal and written communication skills.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
• Essential Accountabilities
• After identification of business need, independently design and conduct analyses by exercising sound judgment in approach and development of analytical assumptions and constraints, interpret results and draw conclusions, and develop feasible alternate courses of action.
• Present results of analytics and make recommendations to management as it relates to business questions related to reimbursement and pricing.
• Create analytical tools to support the organization's strategic initiatives and utilize tools to inform reimbursement and pricing decisions.
• Demonstrate understanding of reimbursement methodologies and underlying coding requirements (e.g., DRG, CPT, & diagnosis codes) as deployed across provider networks and services.
• Conduct analyses of provider networks, patterns and profiles, medical cost and utilization trends and drivers, and provider reimbursement and fee change models.
• Advise and make recommendations to management concerning reimbursement and regulatory changes that have the potential to impact on the organization's financial performance by interpreting the changes and applying in depth knowledge of the subject matter.
• Document clearly all procedures/steps and results/findings.
• Validate data, ensuring report/information accuracy through quality assurance methodologies and balancing procedures.
• Participate in or lead corporate initiatives related to data warehousing, data integrity, new administrative platforms, and treatment cost estimators.
• Build trust and confidence in appropriateness and accuracy of reports and analysis.

Benefits

Additional Information

FIND YOUR FUTURE We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

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