Job ID: 248694
Provider Network Pricing Analyst
Additional Job Information
Title: Provider Network Pricing Analyst
City, State: Indianapolis, IN
Location: ININD 10330 St Vincent Health
Department: Managed Care Contracting
Additional Job Details: FT, Days
Researches, analyzes, and reconciles managed care contracts and utilization patterns.
- Conducts financial modeling and analysis by utilizing a modeling system (or develops tools to model against) to support negotiating strategies, modeling current and future facility and physician contract rate proposals.
- Analyzes changes to reimbursement rule and regulations for all payers, evaluates impact on hospital and physician reimbursement, and educates appropriate personnel.
- Reviews and evaluates the language of the Managed Care contracts and participates in negotiations, as needed. Identifies any compliance issues and coordinates contract workflow/approval through legal review to contract execution.
- Maintains all contract management software and content related to executed contracts and modeling, ensuring data integrity and consistency.
- Analytical support of Regional Director as it relates to Managed Care contracts and payment issues.
- Generates regular and ad-hoc reports for clinical and financial review and trending to analyze and compare information related to clinical procedures, payer categories, volume, net income, net loss charges, costs, revenue, and variances.
- Follows company policies and procedures.
- Must be able to travel to other company sites or business functions, as needed.
- May provide education and training to staff or third party vendors, as needed.
- Must be able to cross-train and support other regional analysts.
- Performs other duties as assigned or as needed by the business.
Complexity of Work:
Within scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment.
Personal Protective Equipment:
Follows Standard Precautions using personal protective equipment as required.
- Bachelor’s degree in statistics, economics, accounting, finance, health administration, or another related field is preferred.
- MHA or MBA preferred.
- Two (2) years of experience preferred in finance or financial analytics, preferably related to insurance reimbursement for healthcare services. Preferred two (2) years of experience in hospital, health system, health plan, or healthcare operations with experience in reimbursement, revenue cycle, or Managed Care contracting.
- Skilled in supporting contract negotiation, working with databases and spreadsheets, giving presentations, critical and analytical thinking.
- Contracting knowledge, preferably in Managed Care and Revenue Cycle.
- Proficiently utilizes Microsoft Excel.
- Negotiating skills.
- Strong analytical skills.
- A personal presence which is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values.
- Ability to work collaboratively in a team environment or independently, as applicable.
- Communicates professionally and effectively in written and verbal manner with payers, third-party administrators, health plan networks, negotiating agencies, department manager and director, as well as other departments within the organization.
- Abides by policies and procedures that ensure consistency with the organization’s mission and directives.
- Investigational and analytical skills with a proven ability to communicate effectively in both written and verbal format.
- Effective problem solving and excellent customer service.
- Takes initiative to identify barriers and opportunities and provides solutions through process and operational improvements.
- Displays good verbal and written communication skills, and able to professionally receive and follow oral instructions.
- Exceptional attention to detail and demonstrated ability to prioritize tasks to ensure accuracy and timely completion.
- Ability to anticipate obstacles to a goal and initiates appropriate resolution. Takes initiative to identify barriers and opportunities and provides solutions through process and operational improvements.
Equal Employment Opportunity
Ascension Health participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.
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