Sr Analyst Payer Contracting

Nicklaus Children's Health System; Sunset Corners (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

Nicklaus Children''s Health System in Florida seeks a Sr Analyst Payer Contracting to drive financial modeling for Commercial FFS, Medicaid, and value-based initiatives. You will develop complex analytics used in negotiations with the VP of Population Health and Payer Strategy.

You will lead automated reporting, support care pricer and EPIC items, and collaborate across teams to ensure accurate contract loads and timely rate updates.

Qualifications

• Bachelor's degree in business, healthcare administration, or finance.
• 4-7 years of experience in Medicaid, managed care contracting, payer analytics, strategic planning, and data modeling.
• Experience with Medicaid and value-based contracts is preferred.
• Advanced Excel modeling and automation skills are essential.
• Experience with BI systems is beneficial.
• Familiarity with EPIC is a plus.

Responsibilities

• Perform complex analytics on Medicaid and value-based contract proposals; evaluate financial impact and provide recommendations.
• Support contract negotiations with financial analysis that ties together complex concepts.
• Develop automated reporting for Medicaid, managed care, and value-based programs.
• Analyze and audit contracts to understand financial impact and proper rate loading.
• Lead the development of annual managed care net revenue budget package.
• Enhance revenue trend reporting for leadership.

Skills

Advanced Excel

Automation

Business Intelligence

Data manipulation

Communication

Problem solving

Multitasking

Contract auditing

Education

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

Master's degree preferred

Tools

FinThrive (MedAssets)

EPIC

Job description

Job Summary

The Sr Analyst Payer Contracting is responsible for financial modeling of all Commercial FFS and Value Based Managed Care and Managed Medicaid initiatives. Develops complex contractual financial analytics and models used during negotiations performed by Vice President of Population Health and Payer Strategy.

Job Specific Duties

• Performs and leads complex analytics on Medicaid and Value Based contract proposals; evaluates financial impact and makes well thought out, logical recommendations.
• Supports contract negotiations with financial analysis that ties together complex, multidisciplinary concepts impacting reimbursement.
• Continuously maintains, creates, and implements automated reporting mechanisms to effectively manage Medicaid, Managed Care, and Value Based business by providing proactive trending/impact by key metrics and statistics.
• Maintains engagement and awareness of Managed Care and Medicaid Industry related initiatives impacting funding and reimbursement to Children's Hospitals
• Provides analytics support of DPP and PSPP programs. Works as needed with outside entities and consultants on development of analytics packages and reporting.
• Develops and performs in depth analytics utilizing various tools and provides recommendations on streamlining and automation to improve efficiency
• Supports in JOC and MOR presentation preparation.
• Works cross functionally with Ensemble partners to ensure proper managed care contract loads and performance. Ensures rate updates are made timely and accurately. Develops reporting to audit expected payment calculations and identify contractual rate areas that need to be addressed.
• Leads the development of the annual managed care net revenue budget package.
• Develops/enhances managed care volume/net revenue trend analysis reporting suite to ensure timely access to relevant information needed by leadership.
• Supports in Care Pricer estimator issues, transparency data needs, insurance plan code master changes, and all EPIC related items.
• Develops/enhances/supports in Global package pricing development.
• Increases utilization and integration of Turquoise price transparency tool into the Managed Care negotiation workflow.

Minimum Job Requirements

• Bachelor's Degree in Business Administration, Healthcare Administration, Finance or related field
• 4-7 years of experience in business planning and analytics (Medicaid, managed care contracting, payer
  analytics, strategic planning, business development, financial analysis, forecasting, and data modeling)

Knowledge, Skills, and Abilities

• Master's degree in Business, Healthcare Administration, or related field preferred
• Experience with FinThrive (previously known as MedAssets), or similar contract management tool system preferred
• Experience working with EPIC a plus
• Extensive experience using Business Intelligence systems
• Advanced Excel modeling, formulas, and automation skills
• Ability to manipulate large data sets and transform into usable and relevant information in support of strategic asks
• Excellent verbal and written communication skills
• Able to maintain confidentiality of sensitive information
• Ability to problem solve and formulate a plan of action
• Able to analyze and audit contracts; ability to understand the big picture and focus in on appropriate areas to model and assess financial impact
• Strong ability to multitask and pivot as needed
• Able to execute and follow through on tasks
• Knowledge of reimbursement terminology and contract testing
• Knowledge of all payer healthcare reimbursement methodologies (e.g., Government and non- government)
• Demonstrates competency in financial and statistical reporting, design, preparation of spreadsheets and other financial reports
• Strong problem-solving skills; open and adaptable to constructive criticism
• Ability to work in high pressure/deadline driven environment.
• Strong attention to detail and ability to tie overarching big picture strategy to detailed analytic approaches to test/prove/disprove hypothesis.