Payor Contracting Sr. Financial Analyst/Full Time/Hybrid

GENERAL SUMMARY:

Under supervision of Manager and / or Director, support the managed care contracting function by performing necessary financial analysis to evaluate payor (or health plan) contract performance and payor rate proposals during contract negotiations and throughout the contract year. This includes benchmarking to regional averages, comparing to Government fee schedules and analyzing existing healthcare (claims) data and reimbursement terms and payment methodologies; with the goal of driving necessary improvement in net revenue for the health system.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

1. Perform deep dive financial analysis to develop and evaluate rate proposals and evaluate health plans financial performance.

2. Monitor contract specific payor rates and identify opportunities for improvement.

3. Review rate sections of proposed contracts and amendments to ascertain that all necessary reimbursement terms are included, and rates are depicted as negotiated.

4. Prepare plan level volume and profitability reports routinely and update as needed.

5. Assume active role in implementation and maintenance of contract management and pricing systems.

6. Develop "what if" scenarios and models in Excel to quickly assess margin impact of changing various reimbursement components.

7. Validate inpatient and high dollar outpatient payments for various payors, including MA, Medicaid and Commercial.

8. Create prospective and retrospective analyses to assess payment discrepancies or opportunities for revenue capture.

9. Develop queries and reports to extract claims and payor data from dbase reporting tool.

10.Perform other duties as assigned.