Contracting Analytics Specialist, Full Time- Days

About the role

Join Uchicago Medicine as a Contracting Analytics Specialist in the Finance department. This position is primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area.

Responsibilities

• Build and model all third-party payer contract reimbursement terms including but not limited to Managed Care Commercial payers, Government programs (Medicare, IL Medicaid), Medicare Advantage payers and Medicaid MCO payers in UCM’s contract management systems or internally developed models.
• Interpret these analytical models for all system entities to meet UCM long-term financial goals.
• Serve as a managed care subject matter expert for hospital, physician, and other ancillary contract rate and language terms.
• Run analyses to understand historical trends and future performance of existing and proposed contracts for internal benchmarking and reporting.
• Assist in strategic pricing analysis to support payer rate parity and pricing transparency work including periodic market comparisons and surveillance.
• Aid in providing committee, EVP, and Board presentation materials on topics related to contract financial terms in support of VP of Payer Contracting & Strategy and CFO.
• Provide contract rate or language information to other teams across the organization in a formal or ad hoc setting.
• Develop robust financial business analytics to determine operational impacts and reporting needs, especially with regard to managed care business and the goal of revenue optimization.
• Utilize contract management system to inform rate analyses and perform regular maintenance and auditing of contract management rate calculations to check for variances to expected contract terms.
• Continued education on ever-changing reimbursement rules and policy updates both commercial and governmental that impact expected reimbursement and contract models and education of internal stakeholders on reimbursement terms, methodology and impacts as needed.

Requirements

• Requires a Bachelor’s degree, preferably in finance or a related field.
• Requires a minimum of three or more years of related health care experience in financial analysis and data models and a record of successfully completing similar duties, demonstrating considerable knowledge of health care organizations, operations, finance, and managed care.
• Experience in multi-facility health system, large academic and community physician groups or clinically integrated network, large academic medical center or insurer environment highly desirable.
• Detailed knowledge and experience with hospital and physician complex reimbursement methodologies including FFS and value-based care (VBC) risk reimbursement structures including Medicare and Medicaid.
• Excellent understanding of general healthcare contract language and rate terms.
• Knowledge of physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws.
• Proficient understanding of MS-DRG, APC, EAPG, case rate, stoploss, carveout reimbursement methodologies.
• Proficient understanding of Revenue Code and CPT coding in a clinical/hospital/ASC/physician office setting.
• Proficient manage care contract rate interpretation skills.

Qualifications

• Requires a Bachelor’s degree, preferably in finance or a related field.
• Requires a minimum of three or more years of related health care experience in financial analysis and data models and a record of successfully completing similar duties, demonstrating considerable knowledge of health care organizations, operations, finance, and managed care.
• Experience in multi-facility health system, large academic and community physician groups or clinically integrated network, large academic medical center or insurer environment highly desirable.
• Detailed knowledge and experience with hospital and physician complex reimbursement methodologies including FFS and value-based care (VBC) risk reimbursement structures including Medicare and Medicaid.
• Excellent understanding of general healthcare contract language and rate terms.
• Knowledge of physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws.
• Proficient understanding of MS-DRG, APC, EAPG, case rate, stoploss, carveout reimbursement methodologies.
• Proficient understanding of Revenue Code and CPT coding in a clinical/hospital/ASC/physician office setting.
• Proficient manage care contract rate interpretation skills.

Skills

• Able to develop insightful observations and recommendations for courses of action from the analysis of complex situations, and to relate those concepts clearly and effectively in both spoken and written form.
• Adapts well to rapid change and multiple, demanding priorities with excellent time and project management skills.
• Works effectively in an independent matter and collaboratively with cross-functional teams to meet goals and improve organizational performance.
• Strong analytical and problem-solving skills, and demonstrates a high level of critical thinking in their analytic work.
• Ability to understand and interpret federal regulations and policies, coding guidelines and reimbursement changes.
• Strong attention to detail and well organized.
• Communicates effectively both verbally and in writing.
• Interacts effectively with colleagues in a variety of contexts and forums and contributes as a team player.
• Microsoft Office Suite advanced proficiency, particularly Excel and PowerPoint.
• Strong aptitude for learning additional software or systems as needed, particularly finance and revenue cycle applications.
• Familiarity and aptitude with some form of contract management and/or cost accounting systems for use in data gathering and model analysis highly desirable.
• SQL experience strongly preferred.

Pay

The pay range provided reflects the anticipated wage or salary reasonably expected to be offered for the position. The pay range is based on a full-time equivalent (1.0 FTE) and is reflective of current market data, reviewed on an annual basis. Compensation offered at the time of hire will vary based on candidate qualifications and experience and organizational considerations, such as internal equity. Pay ranges for employees subject to Collective Bargaining Agreements are negotiated by the medical center and their respective union.

Benefits

Review the full complement of benefit options for eligible roles at Benefits - UChicago Medicine .