Primary Responsibilities and Essential Duties
Reporting to the Vice President of Payer Relations Operations, the Analyst will work with the Manager of Analytics to maintain actionable reports and dashboards for health plan payer reimbursement trends and policy. Such responsibilities include, but are not limited to utilization reporting, expect fee analysis, financial metrics, reimbursement and denial trending, PPA analysis and the interpretation and education of payer financial trends for other key contributors in the company in accordance with the core values of Company.
Key Success Factors Include
- Provide reporting aligned with the overall strategy of the company relative to health plans and government payers to achieve short-term and long- term goals. This includes business analysis of payer trends and behaviors by leveraging reporting tools and adopting best practices for efficiency and success.
- Provide technical expertise for data modeling, database design, data mining and segmentation.
- Conduct data verification and validation processes to confirm data accuracy (vetting) prior to reporting.
- Extract and transform data from multiple sources into actionable reporting for use interdepartmentally.
- Gather and integrate data from disparate sources.
- Build models and analyze data to unearth trends and patterns.
- Present and explain information and suggest improvements for company efficiency and effectiveness to key stakeholders.
- Maintain exceptional documentation and report criteria requirements for future reference.
- Work effectively with individuals across multiple departments throughout the organization.
- Embrace, embody and represent the company culture at all times to external and internal constituents.
- Communicate proactively with others within the company as well as the with regional health plans
- Assist with managing and advising the day-to-day operations of the Payer Relations Analyst team and develops new guidelines and infrastructure
- Analyze insurance payment trends by carrier and in aggregate to make recommendations for contract and fee negotiation
- Advise the Payer Relations and Revenue Cycle management team on emerging trends and methodologies and shifting requirements in managed care contracting, payer relations and legal issues
- Provide support as needed with health plan credentialing, fee schedule builds and any other functions required to support the team
- Ability to manage multiple priorities simultaneously.
- Keen understanding of managed care and health plan operations including reimbursement in the clinical laboratory space.
- Ability to work independently, communicate proactively, manage multiple projects and prioritize daily tasks while managing critical deadlines.
- Good presentation, leadership and team-building skills.
- Willingness to travel, if and as required
- Excellent communication and customer service skills
- Superior organizational, listening and problem-solving skills.
- Ability to handle sensitive information and maintain a very high level of confidentiality.
- Possess a very positive attitude and an understanding of the dynamics involved with organizational growth and change.
- Prefer proficiencies in SQL, MS Access, MS Excel, Power BI, Tableau
Required Education & Experience
- High School or Equivalent
- B.S. in Business Administration, Management, Accounting, Finance or similar degree or equivalent experience. (Preferred)
- 5+ years of experience in health care data analysis.