What are the responsibilities and job description for the Network and Provider Performance Analyst position at Point32Health?
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
- Designing and generating various Point32Health reports and financial analytics that focus on medical cost, utilization, membership, trends, and ad hoc requirements.
- Creating actionable information that results in identifying trend drivers and opportunities for improvement in Point32Health and provider performance.
- Working independently to identify and present cost avoidance and cost recovery opportunities.
- Performing financial & utilization analytics required by other departments within Point32Health including Medical Management, Contracting, Payment & Policy, etc.
- 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.
- 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.