Senior Network & Provider Analytics Analyst

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.