Summary
We are seeking a highly motivated and innovative team member to join our growing and dynamic Digital & Analytics team as a Provider Contract & Network Underwriting Lead Analyst.
In this role, you will conduct hospital and professional provider contract underwriting / analysis, partnering with Contracting to deliver unit cost results in line with trend / cost expectations to ensure competitive positioning within the marketplace.
You will evaluate the impact of proposed terms on profitability, trend and other metrics. You will also partner with network management, medical management, and sales units to understand resulting medical expense results and improve future negotiation strategy.
Responsibilities
Analyze impact to trends and economic metrics for facility and professional contract negotiations
Leverage Hospital and Payer Transparency competitor data / insights in contract negotiation modeling
Effectively influence contracting in a strategic fashion and offer meaningful options during negotiations with a provider
Provide ad hoc analysis and deep dives into data as appropriate to support negotiation and provide value to our contracting partners
Summarize and explain findings and recommendations
Proactively identify opportunities for trend reduction and engage contracting to build these into plan where appropriate.
Keep management informed as to the progress of Plan and proactively identify risk and opportunities for meeting the plan results
Work with Provider Management Tool (PMT) Analysts to oversee corrections and update to forecasting tools
Work with matrix partners in the validation and adoption of AMP and NextGen modeling tools
Qualifications
3+ years’ industry experience solving business problems through the application of analytic approaches, particularly in analyzing medical claims experience in TMC and / or Contract Underwriting for Fee for Service and Fee for Value contracts preferred
Knowledge of standard medical coding : CPT, ICD10, HCPC ideal
Proficiency with Excel to perform data mining and reporting functions; familiarity with Access is preferred
Strong analytical and problem solving skills with ability to independently perform analyses and apply statistical models to validate / interpret results
Understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, and utilization management
Strong communication skills to include written, oral and group presentation
Ability to work independently while managing multiple tasks and meeting deadlines
Bachelor's degree in Finance, Economics, Business, Health Policy Analysis, Healthcare Administration, Mathematics or Statistics preferred
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