Sr Payor Contracting Analyst - REMOTE

Summary

Summary: Plans and leads a variety of duties associated with payor contracting analytics. Acts as the senior lead analyst mentoring and guiding junior analyst co-workers. Develops and maintains strategic reporting on key contracting performance trends. Independently creates complex contract models using multiple data sources. Develops, reviews and analyzes statistics, cost and financial reports to support complex payor negotiations. Makes recommendations on payor rate schedules and models in support of organizational strategy. Responsible for monitoring performance-based contracts and identifying performance trends and opportunities, validating contract performance and settlements. Acts as the analytical go-to person for the departmental VP and works closely with executive leadership on key strategic analytical projects.

Education: Bachelor's degree in accounting, finance, business or other quantitative field. MBA/MHA a plus.

Experience: Minimum of five to seven years experience in managed care, plus value-based care or clinical integration arena with demonstrable knowledge of contract, language, performance metrics, and reimbursement methodologies. Must be highly motivated, productive, self-starter, detail and results oriented. Thrives and excels in a fast-pace environment. Demonstrated strong understanding of risk arrangements fee-for-service, and value-based methodologies. Demonstrate working knowledge of health insurance market and other payor product platforms. Must have a comprehensive understanding of varied reimbursement methodologies including risk and shared savings. Exceptional statistical and analytical skills, demonstrating skills in data gathering, organizing and conveying the story and opportunity. Ability to teach and mentor analytical co-workers. Working knowledge of clinical medical management, coding, billing, and claims processing. Strong verbal and written communication skills with the ability to interpret and convey potential or existing opportunities. Must be detail oriented and strive for constant improvement in knowledge of trends in value based managed care. Demonstrated proficiency with software programs including Excel, Word, General Ledger and Decision Support systems a must.