Strategic Provider Reimbursement Analyst

Independent Health Association; Buffalo (NY); Hybrid; USD 65,000 - 75,000; Full time

Job summary

Independent Health Association in Williamsville, NY is seeking a Provider Contracting & Reimbursement Analyst-Intermediate to analyze utilization, claims, and cost data in support of network contract management. You will design analytical tools to draw conclusions and present results to management.

The role requires a Bachelor's degree (MBA preferred) and 3 years of analytics experience. Proficiency in Access, Excel, SQL, SAS, and Microsoft Fabric is expected; hybrid onsite work is required at

Qualifications

• Bachelor's degree required.
• MBA or advanced degree preferred; additional four years of experience may be considered in lieu of degree.
• 3 years analytics experience or an advanced degree plus two years of experience required.
• Experience in data analysis, statistical analysis, business modeling or health care analytics 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.

Responsibilities

• 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.

Skills

Analytics experience

Data analysis

Healthcare analytics

Statistical concepts

Data modeling

Communication skills

Problem framing

Education

Bachelor's degree

MBA or equivalent

Tools

SQL

SAS

Microsoft Fabric

Access

Excel

Job description

Independent Health Association in Williamsville, NY is seeking a Provider Contracting & Reimbursement Analyst-Intermediate to analyze utilization, claims, and cost data in support of network contract management. You will design analytical tools to draw conclusions and present results to management.

The role requires a Bachelor's degree (MBA preferred) and 3 years of analytics experience. Proficiency in Access, Excel, SQL, SAS, and Microsoft Fabric is expected; hybrid onsite work is required at