Analyst, Payment Modeling & Analysis

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As a Payment Modeling and Strategic Analyst, you will play a pivotal role in shaping the financial strategies of our organization. The primary focus of this position is to utilize healthcare claim data and reporting to support Payer Relations and Contracting staff with analysis of charges, payments, and contract analysis. The position will analyze data from various sources and systems for both physician and hospital services in order to present reports to key leadership and staff and to recommend and implement solutions to assist in the contract negotiation, management of contract terms, and decision-making process. Your work will directly impact our ability to provide affordable and high-quality healthcare to our patients.

Minimum Qualifications

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Bachelor’s degree in finance, accounting, economics, general business management, information technology/computer science, engineering, health care management or related field
  
  

Experience

PREFERRED QUALIFICATIONS:

• Familiarity with physician groups and hospitals preferred.
• Direct experience in data analysis, financial analysis and reporting.
• Exposure and/or experience in health care management, related contracting field, health care insurance services/industry, hospital finance and/or healthcare consulting preferred.
• Master’s Degree in a related field or two (2) years of related work experience.
  
  

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Extracts data from various internal and external sources and conducts analysis of revenue for all third-party payer contracts and monitor existing effective payment percentages, in addition to modeling.
• Utilize data analysis tools and techniques to examine financial data, identify trends, and make data-driven recommendations for optimizing revenue streams and reducing costs
• Performs data analysis and creates queries, programs and automation related changes in payer contracts or other programs affecting payment.
• Create financial models and forecasts to predict the financial impact of various payment and reimbursement scenarios, allowing the company to proactively adjust strategies.
• Provide support and create complex presentations, database and spreadsheets utilizing skills with various programs such as Excel, Access and PowerPoint.
• Leads data requirements gathering for problem identification, resolution, and solution design.
• Provides analytical insights from data to drive strategic business decisions.
• Analyze data from various sources and systems in order to present reports to key management and staff and to recommend and implement solutions to assist in the contracting decision making process.
• Develops and maintains Price Transparency files to comply with CMS regulation.
• Conduct market research to understand payment trends, healthcare regulations, and industry best practices, and use this knowledge to inform strategic decisions.
• Performs analysis and reporting to develop and maintain databases to track and trend incentive based reimbursement and investigate areas of improvement to ensure performance is in line with the organizational strategic plan.
• Develop strong relationship with accounting contacts and assist in completing and compiling financial support documentation for value-based external audits.
• Support development of the overall conceptualization, strategy alignment, and design of new value-based reimbursement models for PCPs, specialist, and hospitals.
• Develop a deep understanding and knowledge of market and governmental trends.
• Communicates to all parties the natures, significance and risk factors of corresponding projects.
• Participates in post implementation review of projects.
• Gathers customer requirements to understand business needs and translate into actionable solutions.
• Ensure that payment models and strategies comply with relevant healthcare regulations, coding guidelines, and industry standards.
• Works proactively and cooperatively in group problem-solving situations.
• Engages peers in improving the quality of the work.
  
  

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit for long periods of time.
• Ability to lift, push or pull 5-10 pounds.
  
  

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Standard office environment.
  
  

Skills And Abilities

• Ability to handle and maintain confidential information.
• Ability to work well under high stress conditions.
• Ability to work independently or cooperatively as a team member.
• Ability to adapt to various workloads and assignments.
• Ability to work with multi-disciplinary groups and facilitate meetings.
• Basic understanding of terminology involved with healthcare insurance and healthcare analysis.
• Solid knowledge and capable in computer use, including strong capabilities in ALL Microsoft Professional Office programs including Outlook, Word, Excel, Access, and PowerPoint.
• Ability to prioritize tasks.
• Must have independent decision-making ability.
• Ability to work in a fast paced and rapidly changing environment.
• Must be flexible.
  
  

Additional Job Description

Scheduled Weekly Hours:

40

Exempt/Non-Exempt

Shift:

United States of America (Exempt)

Company

SYSTEM West Virginia University Health System

Cost Center

649 SYSTEM Managed Care and Payer Relations

Address

1085 Van Voorhis Road

Morgantown

West Virginia

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.