Hybrid Senior Data Analyst - Healthcare Economics

Wellmark, Inc.

Iowa (LA)

Hybrid

USD 120,000 - 180,000

Full time

14 days+

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Job summary

Wellmark, Inc. in Des Moines area seeks a Sr Network Economics Analyst to lead, design, implement and maintain provider reimbursement strategies and multi-year agreements, with strong focus on contracting, claims payment procedures and payment policy.

You will mentor colleagues and advise leadership on strategic decisions. You’ll collaborate across Health Network teams, analyze provider data to inform pricing, and communicate insights to drive better outcomes for members and providers.

Qualifications

Bachelor's degree in accounting, finance, business, economics or related field or direct and applicable work experience.
7+ years of relatable experience within the health insurance, healthcare or related financial industry including demonstrated experience performing financial analysis and data modeling preferably in a healthcare setting.
Solid knowledge of and demonstrated ability in Microsoft Excel along with technical proficiency with tools such as Power BI, Tableau, SAS EG and/or SQL.
Knowledge of hospital, physician and other provider payment and contracting strategies.
Demonstrated knowledge of the health insurance industry including delivery systems and managed care concepts; thorough understanding of reimbursement, contracting, claims processing, medical policies.
Experience interpreting claims data, trends and provider utilization in order to determine payment strategy or payment strategy results.
Demonstrated forethought of issues before questioned; ability to research, ask questions and find solutions to potential problems.
Demonstrated problem-solving, quantitative and analytical skills; ability to recognize inconsistencies, analyze for reasonableness and accuracy, research and come to conclusions.
Comprehensive knowledge of nationally recognized provider compensation strategies.
Strong attention to detail (timeframes, resources, parties involved, communication, etc.) in developing and implementing action plans.
Demonstrated ability applying strong analytical, conceptual and strategic thinking skills to negotiate with providers, or the organizations representing them.
Ability to serve as subject matter expert to mentor team members.
Strong presentation skills and the ability to clearly articulate recommendations to business leadership to achieve business results.
HROR highly preferred.

Responsibilities

Lead, design, implement and maintain provider reimbursement strategies, including financial reporting for all providers. Research, document, monitor and implement provider reimbursement related activity and initiatives.
Perform advanced data analysis and insight in support provider reimbursement initiatives. Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations as appropriate.
Consultant with and provide subject matter expertise to Network Economics, Health Network and other Wellmark business stakeholders in the recommendations and enhancements to provider payment strategies and payment policy decisions.
Serve as consultant in collaboration with Network Engagement to provide reimbursement guidance/expertise and payment policies to providers and applicable stakeholders.
Configure, transfer and monitor data that is being processed in the provider payment systems. Collaborate with testing and system implementations and enhancements. Provide business knowledge and payment processing expertise in projects, if applicable.
Collaborate, interface and manage all service level agreements and management of the relationship with all provider payment vendors.
Other duties as assigned.