Sr. Analyst Strategic Pricing & Analytics, Managed Care Contracting

POSITION SUMMARY :

We seek an experienced Senior Analyst, Strategic Pricing & Analytics to join our Health Plan Relations ( HPR ) team. The incumbent will use their demonstrated expertise developing Excel-based financial modeling of managed care contracts to leverage large, complex data sets in the support and preparation, execution, and delivery of extensive financial analyses and models of proposed contracted rates for payer negotiations.

In addition, this role will collect, load, and analyze HPR contract information into the contract database, interpret contract language, research payer and government fee schedules, and perform other data quality and research initiatives.

This position directly impacts AMSURG’s financial statements, as the contract terms and calculations are relied upon to estimate net accounts receivable.

Formal title : Sr. Strategic Pricing Analyst)

Work Schedule : This role is offered on a fully remote basis allowing our Senior Analyst, Strategic Pricing & Analytics to be based anywhere in the country.

ESSENTIAL RESPONSIBILITIES :

• Support the preparation, execution, and delivery of extensive financial analyses and models of proposed contracted rates for payer negotiations using a variety of business intelligence tools and platforms, inclusive of MS Excel, SQL, Power BI, and Tableau reporting.
• Support the coordination with various Business Intelligence and Data Integration teams to ensure consistent, comprehensive enterprise-wide data sets for use in the analysis of managed care contract negotiation
• Support the integration of reporting / visualization requirements and data into an analytics platform.
• Manage and complete the analysis of large, complex data sets.
• Financial modeling of managed care contracts using Excel.
• Review, interpret, and analyze managed care contracts and update database(s) by entering new and updated information, ensuring data quality, validity, and utility.
• Coordinate and communicate within the HPR team and cross-functionally with Business Operations (RCM), Operations, and Finance Departments to ensure timely communication of managed care data / general information and implementation of HPR team’s overarching strategy.
• Refresh, review / quality check, and maintain existing analytic reports to ensure data is current and accurate.
• Oversee and assist in the design, development, and implementation of analytic ad hoc reports.
• Design and complete annual analyses to evaluate the impact of CMS fee schedule updates on AMSURG’s Medicare revenue to inform annual budget planning.
• Analyze the impact of new fee schedules / payer groupers on reimbursement at the CPT code level, as well as in aggregate, based on business needs.
• Research, analyze, organize, and maintain various Payer Fee schedules and Grouper crosswalks.
• Perform reimbursement analysis using various analytic tools for special departmental projects as needed.
• Engage and support the Business Operations (RCM) department through reimbursement analysis and documentation to ensure contract compliance when post-implementation audits of payor’s Explanation of Benefits (EOBs) do not match expected pay rates.
• Display initiative to test and validate complicated reimbursement terms and troubleshoot pricing discrepancies with stakeholders and colleagues when needed.
• Meet or exceed all targets and deadlines.
• Adhere to all company policies and procedures, including Information Security Policies and ensure that AMSURG remains as secure as possible.
• Regular and reliable attendance is required.
• Other duties as assigned.

KNOWLEDGE AND SKILLS :

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and / or abilities required :

• Analytical versality required to address a variety of ad-hoc analytical problems / requests that arise including ability to understand problem, independently define the right analytical approach and execute against the approach.
• Strong organizational skills and ability to organize, manage, and maintain HPR contract documents.
• Excellent communication skills both on the telephone and in person. Ability to read general business information. Ability to compose general correspondence.

Ability to effectively present information to all levels of an organization and respond to questions from all levels of contact.

• Strong critical thinking and problem-solving skills, enabling the individual to address moderate to highly complex problems without supervision, and make recommendations to management on addressing highly complex problems.
• Detail oriented with excellent follow through abilities. Able to handle and prioritize multiple tasks.
• Ability to work in a fast paced and dynamic environment.
• Reliable, team-oriented, and pleasant, with excellent interpersonal skills.
• Relies on extensive experience and judgment to plan and accomplish goals.
• Able to exercise good judgment and positively influence others, including handling confrontations with poise and efficiency.
• Based on business need, the ability to work a flexible schedule, including some evenings and weekends.

Education / Experience :

Bachelor’s Degree from an accredited four-year College or University preferred in a business-related field or in healthcare;

equivalent relevant experience will be accepted in lieu of a degree.

• 3-5+ years working in a combination of managed care / payer rate modeling and / or managed care / payer contract negotiations.
• Financial modeling of managed care contracts using Excel.
• Ability to build financial and statistical models, analyze data, and translate analyses into specific, targeted actions to drive results.
• Prior experience in reimbursement methodologies (including Medicare / Medicaid and other government payors), revenue cycle, statistical modeling, financial reporting, contract management systems or data analytics.
• Experience rate modeling and analyzing various rate methodologies for ambulatory surgery centers, physician payments, and / or anesthesia services.
• Medical and insurance industry terminology.
• Expertise in Microsoft Office applications, with advanced Excel skills including working with VLOOKUPS and complex formulas.
• Demonstrated expertise with complex and large volumes of data using business intelligence tools and platforms, i.e., SQL, Power BI, and Tableau reporting.

OTHER QUALIFICATIONS :

Must be able to handle multiple, simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner.

High integrity, including maintenance of confidential information. Must pass a background check and drug screen.

We are an Equal Opportunity Employer.

We do not discriminate in practices or employment opportunities on the basis of an individual's race, color, national or ethnic origin, religion, age, sex, gender, sexual orientation, marital status, veteran status, disability, or any other prohibited category set forth in federal or state regulations.

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