Overview :
Supports the financial and operational evaluation of prospective Health Plan contracts, providing consulting and recommendations to insure growth and profitability of third-party payors.
Towards this goal, works closely with Health Plan Sales, Regional Finance and Health Plans Finance Contract Support Manager.
Partners with representatives of the Health Plan sales organization in response to contract proposals for regional and national contracts.
Responsibilities :
Performs all financial analyses required for prospective third-party contracts including the compilation of fee schedules, revenue projections, synergy analyses and what-if scenarios.
Calculates specific CAP PMPM rates and develops CPT based fee schedules for key regional and national contracts.
Develops utilization and membership corridors and integrates such corridors into contracts where applicable to protect the Company from downstream risk with capitated arrangements.
Supports the development of standard premium priced tests, capitation carve-outs and overall pricing guidelines.
Works closely with the Clinical Franchise department to ensure that pricing guidelines for high value and new test campaigns are considered in prospective contracts.
Serves as a content expert to regional leadership regarding third party contracts and pricing strategies.
Interfaces directly with regional leadership regarding the price, volume, and cost implications associated with new and existing third-party contracts.
Develops methods to streamline the pricing review and authorization process for third-party contracts.
Performs specific test campaign analyses to determine the prospective revenue and volume impact for key test initiatives.
Partners with Billing function to review, disseminate, and recommend enhancements to third-party data used to build financial models.
Supports the annual budget process providing details and insights on known and potential contract changes in the coming year.
Ad-hoc projects as needed.
Qualifications : Bachelor’s degree
Bachelor’s degree
A minimum of three years relevant financial analysis experience
Strong understanding of the healthcare industry and health plans specifically (product types, trends, etc.)
Strong financial and analytical skills
Innovative thinker comfortable with ambiguity to complete tasks
Ability to work effectively cross-functionally in a matrix environment and build / maintain relationships
Excellent verbal and written communication skills
Ability to work effectively both independently and within a team
Strong PC skills (Excel, Access, PowerPoint, Word)
While we appreciate and value our staffing partners, we do not accept unsolicited resumes from agencies. Quest will not be responsible for paying agency fees for any individual as to whom an agency has sent an unsolicited resume.
EEO :
Equal Opportunity Employer : Race / Color / Sex / Sexual Orientation / Gender Identity / Religion / National Origin / Disability / Vets
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