Payer Operations Analyst

Nicklaus Children's Health System; Miami (FL); On-site; USD 85,000 - 110,000; Full time

Job summary

Nicklaus Children's Health System is seeking a Payer Operations Analyst to lead system-wide payer analytics, negotiate with payers, and support service line, operational, and clinical analytics. The role uses BI, data visualization, and contract modeling tools to deliver strategic recommendations, partnering with Finance, Decision Support, Strategy, and Revenue Cycle teams.

The position requires 3-5 years in financial and data analytics, a Finance/Business background, and experience with

Qualifications

• Bachelor’s degree in Finance, Economics, Business Administration, Health Service Administration, or related field.
• 3-5 years of progressive experience in financial and data analytics.
• MBA or MHA preferred.
• Experience with contract modeling systems (e.g. FinThrive, Epic Contract Modeling).
• Strong analytical skills tied to an ability to understand and incorporate big picture ask in order to make appropriate, data driven recommendations.
• Experience in data analytics related to health plans and/or hospital finance and strategy.

Responsibilities

• Supports in the development and implementation of current, and future state, commercial, and governmental payer analytics reports.
• Demonstrates expertise and leadership in performing/producing intricate financial analysis.
• Responsible for continuous learning and development understanding of Statewide/National managed care and Medicaid payer trends in order to round out ability to produce well thought out and relevant and proactive analysis, with accompanying recommendations/observations for leadership.
• Supports during managed care negotiations by ensuring proactive, timely and appropriate availability of all reporting and analytics for leadership.
• Responsible for timely update and dissemination of a variety of departmental matrices, including but not limited to payer hospital and employed physician rates/participation, charge master increases/notification, behavioral health rates/participation, DPP payment tracking, as well as payer policies, bulletins and updates.
• Responsible for production and coordination of reporting/analytics/research to support payer specific, system wide initiatives.
• Supports in yearly managed care budget analysis and preparation.

Skills

Strong analytical skills

Self-starter

Effective communication

Attention to detail

Problem solving

Education

Bachelor’s degree in Finance, Economics, Business Administration, Health Service Administration, or related field

MBA or MHA preferred

Tools

FinThrive

Epic Contract Modeling

Tableau

Excel

Microsoft Office BI

Job description

Job Summary

The Payer Operations Analyst serves as lead support in system wide governmental and non- governmental payer performance analytics and negotiations, as well as other service line/operational/clinical/professional analytics. Utilizes various software, databases, BI/Data Visualization/Contract Modeling systems, and other applicable resources to meet or exceed objectives. Also works on cross functional initiatives with external collaborators/partners, as well as with internal teams, including but not limited to Finance, Decision Support, Strategy, Global Health, Revenue Cycle, Patient Access, Nicklaus Children's Pediatric Specialists LLC.

Description

The Payer Operations Analyst serves as lead support in system wide governmental and non- governmental payer performance analytics and negotiations, as well as other service line/operational/clinical/professional analytics. Utilizes various software, databases, BI/Data Visualization/Contract Modeling systems, and other applicable resources to meet or exceed objectives. Also works on cross functional initiatives with external collaborators/partners, as well as with internal teams, including but not limited to Finance, Decision Support, Strategy, Global Health, Revenue Cycle, Patient Access, Nicklaus Children\'s Pediatric Specialists LLC.

Job Specific Duties

• Supports in the development and implementation of current, and future state, commercial, and governmental payer analytics reports.
• Demonstrates expertise and leadership in performing/producing intricate financial analysis.
• Responsible for continuous learning and development understanding of Statewide/National managed care and Medicaid payer trends in order to round out ability to produce well thought out and relevant and proactive analysis, with accompanying recommendations/observations for leadership.
• Supports during managed care negotiations by ensuring proactive, timely and appropriate availability of all reporting and analytics for leadership.
• Responsible for timely update and dissemination of a variety of departmental matrices, including but not limited to payer hospital and employed physician rates/participation, charge master increases/notification, behavioral health rates/participation, DPP payment tracking, as well as payer policies, bulletins and updates.
• Responsible for production and coordination of reporting/analytics/research to support payer specific, system wide initiatives.
• Supports in yearly managed care budget analysis and preparation.

Qualifications

Minimum Job Requirements

• Bachelor’s degree in Finance, Economics, Business Administration, Health Service Administration, or related field
• 3-5 years of progressive experience in financial and data analytics

Knowledge, Skills, And Abilities

• MBA or MHA preferred.
• Required experience working with contract modeling systems(e.g. FinThrive, Epic Contract Modeling)
• Strong analytical skills tied to an ability to understand and incorporate big picture ask in order to make appropriate, data driven recommendations
• Experience in data analytics related to health plans and/or hospital finance and strategy
• Background in Managed Care contracting on the provider or payer side a plus.
• Intermediate to advanced level of proficiency in Microsoft Office suite business Intelligence (BI) and data visualization platforms (eg Tableau)
• Ability to work in a high functioning environment with competing priorities and quick pivots without sacrificing quality of work product, all while maintaining a positive and welcoming attitude
• Self- starter; consistently demonstrate judgment and initiative in decision making. Possess effective problem solving skills grounded in independent research but supported by appropriate guidance
• Attention to detail, coupled with organization skills essential; timeliness and responsiveness to requests paramount
• Effective communicator across all levels of the organization

Job

Accounting/Finance

Department

NCHS-MANAGED CARE CONTRACTING-1000-900910

Job Status

Professional