Healthcare Modeling Analyst

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

This is a remote position. 

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. Provides analytical and pricing expertise for the evaluation, negotiation, implementation and maintenance of managed care contracts between CommonSpirit Health providers and payers. Recommends strategies for maximizing reimbursement and market share. Provides mentorship and guidance of Analyst contract modeling. Provides analysis findings and education to key stakeholders.

This position will serve and support all stakeholders through ongoing educational and problem-solving support for managed care payer reimbursement models. 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.

Additional Essential Key Job Responsibilities for the Analyst, Payer Analytics & Economics with a strategic focus on revenue integration and defense may include the following:

• Evaluate and enhance 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.
• Develop reporting to identify, and potentially correct, systematic expected reimbursement modeling variances impacting
  downstream stakeholders (such as Completeness and Accuracy and Calculation Error reporting)
• Support 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
• Review and analyze payer policy impact and collaborate on internal communication and education as applicable to prevent
  adverse impact from payer policy changes
• Assist with research and education for PAE on the impact of various legislative issues and billing, payer, and healthcare
  industry topics as needed.

• Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare or related field. Equivalent education and experience, in related field may be considered in lieu of degree. 
• 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.
• including an understanding of national standards for fee-for-service and value-based provide 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.
• Must have MS Excel.
• Strongly desire Basic technical understanding and proficiency in SQL queries, MS Visual Basic, PIC, or other related applications.
• Working knowledge of financial statements and accounting principles.

#LI-CSH