Network and Provider Performance Analyst

Job Description

The Senior Network and Provider Analytics Analyst will be part of a team responsible for the development, negotiation, monitoring and reporting of contractual agreements with healthcare providers and institutions. The responsibilities include supporting provider negotiations, regulatory submissions, RFP/UDS submissions (as well as finding improvements) and ad hoc requests.

Key Responsibilities/Duties

1. Designing and generating various Point32Health reports and financial analytics that focus on medical cost, utilization, membership, trends, and ad hoc requirements.
2. Creating actionable information that results in identifying trend drivers and opportunities for improvement in Point32Health and provider performance.
3. Working independently to identify and present cost avoidance and cost recovery opportunities.
4. Performing financial & utilization analytics required by other departments within Point32Health including Medical Management, Contracting, Payment & Policy, etc.
5. Utilizing in-depth understanding of reimbursement methodologies and trends in managed care finance, leading the development and analysis of new reimbursement strategies and financial analytics supporting provider contracting in the Point32Health network.
6. Ongoing communication with customers, providing project status, resolving issues, coordinating continued involvement to meet original expectations, or jointly agreed upon adjusted expectations.

Qualifications – What You Need To Perform The Job

• Bachelor's in Business Administration, Finance, Health Services required; Master's 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 healthcare claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment.
• Strategic thinker, with strong analytic and problem-solving skills. Strong interpersonal and collaboration skills, and the ability to work in a team environment required.