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
Business Analytics Lead Analyst (Provider Network Contracting & Underwriting) - Hybrid
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. Effectively influence contracting in a strategic fashion and offer meaningful options during negotiations with a p...
Functional Analyst Lead - Hybrid - 132014
Functional Analyst Lead - Hybrid - 132014. The Functional Analyst Lead will provide direction and guidance to a team of analysts and/or assistants who are the points of contact for timekeeping and payroll-related inquiries servicing UC San Diego Health System employees. Functional Analyst Lead - Hyb...
Lead Product Business Intelligence Analyst
The Lead Business Intelligence Analyst for product will have proven experience driving organizational change with data through product outcomes, standing up new analytical capabilities, championing the use of best practices and staying current with the latest and greatest in the field of data analyt...
Sr. Business Systems Analyst (bsa)
Business Systems Analyst (BSA). Assist and support senior project manager and business lead as needed. A VIDEO interview will be required and the selected candidate will work in hybrid manner, with at least 2 days per week in the Long Beach office. Business/system requirements analysis, user support...
ServiceNow Senior Business Systems Analyst - Hybrid role
SERVICENOW SENIOR BUSINESS SYSTEMS ANALYST – Hybrid role. Demonstrated ability in consultative capabilities by providing thought leadership to sponsors/stakeholders in solving business process and/or technical problems by focusing on providing options which identify the pros and cons of those option...
Client Account Support Lead Analyst - Hybrid - Walnut Creek, CA - Cigna Healthcare
The Sales Client Account Lead Analyst role is a key member of the Client and Growth Services organization, providing advanced professional input to complex Client Services geographically assigned local market book of business and projects for a designated region, while working collaboratively across...
Market Engagement Lead Business Analyst (Business)
In this exciting role as a Market Engagement Lead – Business Analyst, you will play a crucial role in assisting small business customers. Your primary objective will be to help these businesses understand and take advantage of energy and cost-saving incentives to boost their operations. Your key res...
Lead Analyst, Analytics
BI or digital analytics tools (Tableau, Adobe analytics, Google analytics, DMP insight tools). Merkle is a leading technology-enabled, data-driven customer experience management (CXM) company. For over 30 years, Fortune 1,000 companies and leading nonprofit organizations have partnered with us to bu...
Senior ERP Business Analyst (PPM/Grants) - Hybrid Remote
The Senior ERP Business Analyst - Hybrid Remote supports the implementation of various applications along with the integration of those systems. Cedars-Sinai has once again solidified its position as a global healthcare technology leader, receiving top accolades in not one but two prestigious survey...
Senior Analyst, Business Analytics
The Pricing Operations Senior Analyst will review guarantee performance by client on a monthly basis, prepare financial performance reporting, provide reporting and information for audit requests, and partner with Underwriting, Networks, Sales/Account Management, Audit and Legal, to review contract ...