Sr Financial Analyst - Provider Contracting

Overview

is seeking a Sr Financial Analyst in its Provider contracting department.

The Senior Financial Analyst is responsible for financial and market analytics that support clinical provider contract negotiations and network development activities through analyses and reporting of critical information including utilization data.

The Senior Financial Analyst will make recommendations regarding implementation of various reimbursement models, rate strategies, and contract terms along with remaining current on industry trends and regulations affecting provider reimbursement, claims payment and modeling systems capabilities, and provider reimbursement methodologies such as changes to Medicare, Medicaid, State or Federal reimbursement mandates and Pay for Performance models.

The Senior Financial Analyst will also provide complex financial support to senior leaders and identification of market dynamics and cost trend initiatives that affecting the organization’s medical expenditure and potential cost savings opportunities.

Major Responsibilities / Essential Functions

• Analyzes contract proposals, calculates financial impact, develops scenarios and counter proposals to maximize savings or minimize increases.
• Provides complex financial support to the senior leaders specific to major strategic contract initiatives, especially in the development and management of provider network(s) and innovative payment models that support growth and financial objectives.
• Creates, maintains, and compares rates and proposals against internal and external benchmarks to aid in crafting counter proposals.
• Develops and maintains rate guardrails to enable fast-track negotiations.
• Performs QA / review of analytics to ensure data quality is preserved and accuracy in calculations is maintained.
• Demonstrates expertise in knowledge of Medicare and Medicaid reimbursement methodologies for various Provider Types Physicians, Inpatient and Outpatient Hospitals, ASCs, SNFs, Home Health, Hospice, Alternative Health etc..
• Monitors changes and updates in CMS / State regulations for RVUs, DRGs, APCs, ASCs, SNFs, Home Health, Hospice etc. on an annual or quarterly basis.
• Possesses an understanding of Alternative Payment Methodologies, including those based on performance, risk, capitation etc..
• Validates configuration documents to ensure they accurately reflect the compensation terms of the negotiated contract.

Monitors claims payments to ensure contract terms are being adjudicated as intended. Facilitates resolution to auditor questions by reconciling claims payment with contract terms.

• Designs and develops Performance Reporting for the department via Scorecards focusing on financial trends, contract turnaround time, and timeliness of submissions to Claims department, among other metrics.
• Responds to requests for data and analysis by OR and WA states, such as on Mental Health Parity and All-Payer Claims Database.
• Partners in performing Make / Buy analysis in care delivery externalization business cases.

Minimum Qualifications -

• Bachelor’s degree in Finance, Accounting or Business required or equivalent education and experience.
• Minimum five (5) years of expert level knowledge in Financial Analysis and the use of MS Office applications and relational database design concepts.
• Must understand and have working knowledge of all aspects of Managed Care, both institutional and professional, contracting by line of business including by not limited to Commercial, Medicare and Medicaid, capable of developing and incorporating into contracting strategy and reimbursement methodology.
• Must understand and have working knowledge of provider contract types, concepts and data.
• Experience in analyzing and modeling provider contracts involving various current rate methodologies : MS-DRG, APC, CPT, Capitation, Fee-for-Service, RBRVS, Per Diem, Per Case and Percent of Charges;

and at a minimum, an understanding of performance / risk-based payment concepts and structure.

• Strong computer skills with either SAS or SQL, advanced knowledge of Microsoft Excel and other analytics or database software.
• Knowledgeable in managed care contracting principles and language and regulatory requirements.
• Knowledgeable in Medicare and Medicaid reimbursement methodologies and the associated regulations and requirements.

Preferred Qualifications -

• Master of Business Administration (MBA) or Public Health (MPH) or Master of Arts (MA) in Finance, Accounting, Economics, Healthcare Administration or related field or equivalent combination of education, knowledge, and work experience.
• Five (5) years of experience in working with Medicare and Medicaid and managed care rate setting and contract modeling in either a healthcare provider or a health plan environment.
• Five (5) years of experience working with financial analysis supporting managed care contracting with providers including but not limited to hospitals, professionals ranging from large medical groups to solo practitioners, mental health practitioners, ASCs, skill nursing facilities, renal dialysis facilities, home health and DME.

Current working knowledge of all aspects of a provider contract.

• Five (5) years of expert level knowledge in the use of MS Office applications and relational database design concepts.
• Knowledge of health care delivery systems and operations, specific knowledge of Kaiser Permanente medical care delivery operations and systems highly desired.
• Experience with relevant corporate data systems including Tapestry, Financial Modeling System.

For more information about this position, contact Courtney Johnson,