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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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