Payer Analytics Economics Analyst

CommonSpirit Health; Chicago (IL); Vor Ort; USD 47.000 - 70.000; Vollzeit

Zusammenfassung

CommonSpirit Health in Chicago, IL seeks a Payer Analytics and Economics Analyst to leverage data-driven insights for payer relationships, contract performance, and the financial health of the organization.

You will analyze payer contracts, claims data, and market trends to identify opportunities for revenue enhancement, cost reduction, and improved contract terms, using strong analytical and financial modeling skills and a solid understanding of reimbursement methodologies.

Qualifikationen

• Bachelor's degree in Business Administration, Accounting, Finance, Healthcare or related field; equivalent education/experience may be considered.
• One 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 profitability analysis and data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.

Aufgaben

• Perform strategic pricing analysis to support negotiation of reimbursement rates and related terms in managed care contracting initiatives.
• Monitor contract financial performance and publish managed care performance statements.
• Provide stakeholder training on modeling proposed/existing negotiated payer contracts with revenues, volumes, and regulatory changes.
• Act as liaison between CommonSpirit Health and payer to update reimbursement information.
• Prepare service line reimbursement analyses and develop models to assess new/revised strategies and rate structures.
• Identify and access relevant internal and external data resources to support analyses.

Kenntnisse

Analytical skills

Quantitative analysis

Financial modeling

Healthcare reimbursement

Payer contracting

Managed care economics

Ausbildung

Bachelor's degree in Business Administration/Accounting/Finance/Healthcare or related field

Jobbeschreibung

Job Summary and Responsibilities

As our Payer Analytics and Economics Analyst, you will be instrumental in leveraging data-driven insights to optimize our payer relationships, contract performance, and overall financial health.

Every day you will analyze payer contracts, claims data, and market trends to identify opportunities for revenue enhancement, cost reduction, and improved contract terms.

To be successful in this role, you must possess strong analytical, quantitative, and financial modeling skills, a comprehensive understanding of healthcare reimbursement methodologies, payer contracting, and managed care economics.

• Perform strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives. Develop financial models and payer performance analysis.
• Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability. Review and accurately interpret contract terms, including payer policies and procedures impacting contract performance.
• Provide stakeholder training of the modeling of proposed/existing negotiated payer contracts, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
• Act as a liaison between CommonSpirit Health and payer to update information and communicate changes related to reimbursement.
• Prepare service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provision, parameters and rate structures aimed at establishing appropriate reimbursement levels.
• Identify, collect, and manipulate from a wide variety of financial and clinical internal data bases (e.g. PIC, STAR, TSI, PCON, EPIC) and external sources. Identify and access appropriate data resources to support analyses and recommendations.

Job Requirements

Required

• Bachelors Other in Business Administration, Accounting, Finance, Healthcare or related field; Equivalent education and/or experience may be considered in lieu of degree.
• 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

Where You'll Work

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Pay Range

$34.00 - $50.58 /hour

We are an equal opportunity employer.