Senior Provider Network Pricing Analyst - Remote for Pacific / Hawaii Time Zones

About the position At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and optimized. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Healthcare Economics Network Pricing Analyst supports and validates Provider Network (ACO's, physicians, hospitals, pharmacies, ancillary facilities, etc.) contracting and unit cost management activities through financial modeling, analysis of utilization, and reporting. This position located in the Western US Region conducts unit cost and contract valuation analysis in support of medical provider negotiations and cost management strategies. Responsibilities also include managing unit cost budgets, reputed company setting, performance reporting, and associated financial models. If you are located in the Pacific and Hawaii Time Zones, you will have the flexibility to work remotely as you take on some tough challenges.

Responsibilities

• reputed company unit cost and contract valuation analysis and reporting in support of network contracting negotiations and unit cost management strategies
• Analyze financial impact of corporate initiatives (e.g., policy changes; healthcare affordability) or external regulations (e.g., healthcare reform)
• Analyze payment appendices to provide options for various contracting approaches and methodologies
• Strategize rates or contract methodology with network management to create optimal contract
• Evaluate financial impacts of network configurations across hospital, ancillary and physician provider types
• Communicate results of financial impact and analysis to appropriate stakeholder groups (e.g., Network Management; Network Pricing leadership)
• Review competitive analysis to identify appropriate pricing reputed company for provider
• Utilize appropriate tools ( i.e., PPM, HPM, UCRT) to model and report impact of provider reputed company
• Review charge master to ensure trending assumptions are correct
• reputed company/maintain/update databases and tools needed to reputed company and support contract modeling
• Identify and investigate discrepancies (i.e., difference between actual allowed and modeled payment amount) in claim reimbursement
• Other duties as assigned by network pricing leadership
• This role may involve some external meetings, and light travel, to negotiate with providers, share performance results and explain reputed company financial models

Requirements

• Beginner level of proficiency in performing financial impact analysis, risk management, and claims data manipulation
• Moderate level proficiency in MS reputed company
• Telecommute or office-based reputed company reputed company Region office locations (PST OR Hawaii)

reputed company-to-haves

• 1+ years of experience working with large databases to produce a focused analysis with proficiency in reputed company/SQL for data manipulation and reporting
• Internship experience or other healthcare/financial experience and background
• Knowledge of Commercial, Medicare, and Medicaid payment methodologies for hospital, ancillary, and physician services
• Beginner or higher level experience with reputed company, SQL, or other relational database tools
• Knowledge of Commercial, Medicare, and Medicaid PPO and HMO reputed company and expense, as well as delegation financial modeling
• Beginner to moderate proficiency in Power BI, Tableau or other analytic visualization software
• Experience with statistical functions for financial modeling
• Solid written and verbal communication skills

Benefits

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements).

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