What are the responsibilities and job description for the Senior Health Insurance Reimbursement Analyst position at Health New England?
Purpose
The Senior Reimbursement Data Analyst prepares the financial and statistical analysis related to in/out-of-network providers within the Health New England’s service areas. As a member of the Finance team, the Senior Reimbursement Data Analyst is responsible for building, supporting and ensuring data integrity in support of contract modeling. The position will serve as a partner with the Contracting Department and other HNE organizational departments. As an individual contributor, the Senior Reimbursement Data Analyst will possess strong quantitative, technical, analytic and interpersonal skills.
Job Responsibilities
- Supports the development and maintenance of tools for new and renewing provider reimbursement analysis through the use of internal membership, provider and claim databases
- Assists in implementation of vendor software for repricing claims using CMS reimbursement methodologies
- Subject matter expert and point person for ensuring updates to vendor software are implemented in modeling
- Creates and supports competitive positioning and benchmarking analysis
- Assists in measurement of provider cost and utilization performance for use in quarterly product pricing and annual budgeting/forecasting
- Manages and enhances large technical financial and statistical databases working in conjunction with other departments and IT as necessary
- Analyze and improve contracting value through identification and recommendations to create bundled reimbursements, from previous unbundled services
- Extensive knowledge in ICD, CPT, HCPCS, 3rd party payer requirements, federal and state guidelines and regulations pertaining to coding and billing practices
- Verifies and analyzes rate calculations submitted by hospitals and other providers for accuracy during the rate negotiation process
- Stays abreast on the latest reimbursement principals, governmental regulations and requirements (CMS, etc.)
- Responsible for the timely completion of external cost studies, prepares financial analysis filings and analysis on current and future reimbursement regulations
- Performs ad-hoc analysis and other job related duties as required
Desired Qualifications
A Bachelor’s degree (MBA is preferred) in Finance, Accounting, Mathematics, Statistics, Actuarial, Data Science or related field.
- Minimum of 5-7 years of progressive work experience in a health care analytics department setting (Healthcare Decision Support in managed care or hospital setting preferred)
- Advanced technical skills with minimum of three years writing new SQL/SAS scripts and running existing scripts (Required)
- Ability to recognize opportunities for innovation in reporting and work product
- Ability to multi-task when faced with competing deadlines
- Advanced Excel (pivot tables, V Lookups, macros etc.)
- Displays positive customer focus and able to work independently with deadline orientation
- Excellent analytical skills driven by a powerful inquisitiveness and curiosity about data
- Experience with database and large data set usage; including reporting, management and manipulation for analytical purposes
- Knowledge of healthcare financial analysis, trending, projections and analytic software models
- Participates in continual learning related to CMS and Commercial reimbursement methodologies
- Proficiency with innovating and developing new tools for end user’s needs
