Payer Analytics Economics Analyst

Job Summary

You will leverage data-driven insights to optimize payer relationships, contract performance, and financial health. Your responsibilities include analyzing payer contracts, claims data, and market trends to identify opportunities for revenue enhancement, cost reduction, and improved contract terms.

Responsibilities

• Analyze payer contracts, claims data, and market trends to identify opportunities for revenue enhancement, cost reduction, and improved contract terms.
• Perform strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives.
• Develop financial models and payer performance analysis.
• Maintain contract financial performance.
• Analyze and publish managed care performance statements and determine profitability.
• Review and accurately interpret contract terms, including payer policies and procedures impacting contract performance.
• Provide stakeholder training on the modeling of proposed/existing negotiated payer contracts, including expected and actual revenues/volumes, past performance, proposed contract language, and regulatory changes.
• Act as a liaison between CommonSpirit Health and payers to update information and communicate changes related to reimbursement.
• Prepare service line reimbursement analyses and financial performance analyses.
• Identify, collect, and manipulate from a wide variety of financial and clinical internal data bases (e.g. PIC, STAR, TSI, PCON, EPIC) and external sources to support analyses and recommendations.

Requirements

• Bachelor's degree in Business Administration, Accounting, Finance, Healthcare or related field; equivalent education and/or experience may be considered in lieu of degree.
• One (1) year of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies.
• Experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.