Payer Analytics Economics Analyst

Where You’ll Work

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Job Summary and Responsibilities

As our Payer Analytics and Economics Analyst, you will be instrumental in leveraging data-driven insights to optimize our payer relationships, contract performance, and overall financial health. Every day you will analyze payer contracts, claims data, and market trends to identify opportunities for revenue enhancement, cost reduction, and improved contract terms. To be successful in this role, you must possess strong analytical, quantitative, and financial modeling skills, a comprehensive understanding of healthcare reimbursement methodologies, payer contracting, and managed care economics.

• 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.
• Monitor 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 of 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 payer to update information and communicate changes related to reimbursement.
• Prepare service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provision, parameters and rate structures aimed at establishing appropriate reimbursement levels.
• 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. Identify and access appropriate data resources to support analyses and recommendations.

Job Requirements

Required

• Bachelors Other in Business Administration, Accounting, Finance, Healthcare or related field and 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,
• Equivalent education and/or experience may be considered in lieu of degree., 
• 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 contribution 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