Senior Network & Provider Analytics Analyst
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Role Description
Working under the direction of the Director or Senior Manager, the Senior Analyst will be part of a team responsible for the development, negotiation, monitoring and reporting of the contractual agreements with health care providers and institutions.
Support provider negotiations, regulatory submissions, RFP/UDS submissions, and ad hoc requests.
May serve as a project manager and/or lead cross-functional teams for certain related projects.
Responsible for designing and generating various Point32Health reports and financial analytics focusing on medical cost, utilization, membership, trends, and ad hoc requirements.
Create actionable information based on detailed analytics to identify trend drivers and opportunities for improvement in Point32Health and provider performance.
Translate complicated and technical analytics into concise and easily understood recommendations.
Identify and present cost avoidance and cost recovery opportunities independently.
Perform financial & utilization analytics required by other departments within Point32Health including Medical Management, Contracting, Payment & Policy, etc.
Lead the development and analysis of new reimbursement strategies and financial analytics supporting provider contracting in the Point32Health network.
Responsible for ongoing communication with customers, providing project status, resolving issues, and coordinating continued involvement to meet original or adjusted expectations.
Other duties and projects as assigned.
Qualifications
Bachelors in Business Administration, Finance, Health Services required; Masters preferred.
5-7 years of business experience, preferably in managed care or provider environment.
Advanced Excel skills; proficiency with SAS/SQL programming required.
In-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers.
Solid knowledge of health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment.
In-depth health care reimbursement and managed care business knowledge with specialized technical and analytical skills.
Strategic thinker, with strong analytic and problem-solving skills.
Strong interpersonal and collaboration skills, and the ability to work in a team environment required.
Benefits
Medical, dental and vision coverage.
Retirement plans.
Paid time off.
Employer-paid life and disability insurance with additional buy-up coverage options.
Tuition program.
Well-being benefits.
Full suite of benefits to support career development, individual & family health, and financial health.
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