Provider Contract & Reimbursement Analyst supporting Network Contract Management and corporate strategic initiatives. Analyzing claims, membership, and cost data for health care reimbursements.
Responsibilities
analyze utilization, claims, membership, and cost data in support of the Network Contract Management department and corporate strategic initiatives
design and use analytical tools to draw statistically sound conclusions and present results to management
interpret, analyze, and recommend courses of action to management as it relates to fair, equitable, and market competitive reimbursement
support provider contract negotiations, assess the impact of potential alternative reimbursement models
improve the ability to deliver high quality high value care
Requirements
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 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
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