Provider Contracting & Reimbursement Analyst-Intermediate

Independent Health; United States; Hybrid; USD 65,000 - 75,000; Full time

Benefits offered by this job

scorecard incentive

full range of benefits

generous paid time off

Job summary

Independent Health in Williamsville, NY is seeking a Provider Contracting & Reimbursement Analyst-Intermediate to analyze utilization, claims, membership, and costs across provider networks. You’ll design analytical tools, interpret results, and present actionable recommendations to management to support fair, market-competitive reimbursement and value-based care initiatives.

The role is hybrid with on-site attendance at our Williamsville location.

Qualifications

• Bachelor’s degree is required.
• MBA or equivalent advanced degree preferred.
• Three (3) years of analytics experience OR an advanced degree plus two years of experience required.
• Experience in data analysis, statistical analysis, business modeling or healthcare analytics/health informatics preferred.

Responsibilities

• Independently design and conduct analyses after identifying business needs.
• Present results to management and make reimbursement/pricing recommendations.
• Create analytical tools to support strategic initiatives and inform reimbursement decisions.
• Demonstrate understanding of reimbursement methodologies and coding requirements across provider networks.
• Analyze provider networks and cost/utilization trends and driver changes.

Skills

Access

Excel

SQL

SAS

Healthcare analytics

Education

Bachelor's degree

MBA

Tools

Microsoft Fabric

Job description

Overview

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.

Qualifications

• 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.
• Participate in or lead analytics and research associated with alternative reimbursement and other initiatives by identifying, assessing, and interpreting impact of alternate reimbursement methodologies to support the strategic direction of the organization.
• Assess impact on policies and procedures, coordinating with several different disciplines, staff, and management.
• 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.
• Collaborate with other analysts and seek input as needed.

This is a hybrid position with onsite attendance required at our Williamsville location.

The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.

Our core values drive who we are and the work we do.

As a member of our family, you’re part of something special, in your work and in the community.

We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed.

We are here to continue learning and to generate important dialog.

We are committed to doing what matters most - reaching out, working together, and caring for our community.

A healthy community benefits everyone who lives in it.

You too can be part of making difference in the lives of others, together we achieve so much more.

Hiring Compensation Range: $65,000 - $75,000 annually.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off.

• scorecard incentive
• full range of benefits
• generous paid time off

The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affarm Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.

We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans.

Please contact Human Resources at [e-mail] or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.

We do not accept unsolicited resumes.

We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.