Catholic Health Initiatives Analyst Healthcare Economics/Contract Compliance in CHATTANOOGA, Tennessee

Analyst Healthcare Economics/Contract Compliance

Description

Job Summary / Purpose

The Analyst of Strategic Pricing and Contract Compliance provides analytical and pricing expertise for the evaluation, negotiation, implementation and maintenance of managed care contracts between CHI providers and managed care payers or networks. Coordinates and monitors contract performance and compliance. Supports strategies for maximizing contract reimbursement and value. Aids the enforcement of managed care contract terms. Performs complex financial analysis and modeling of contract reimbursement levels and methodologies.

Essential Key Job Responsibilities

  • Act as a liaison across CHI functional areas to update payer contract rate information and communicate changes.

  • Oversee and prepare complex payer contract reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variable and assumptions) to identify the implications/ramifications/results of reimbursement strategies, contract provisions, rate structures, and payer policies aimed at establishing and ensuring compliance with appropriate contract rates.

  • Identify, collect, and manipulate data within multiple contract modeling tools, billing systems, and databases (e.g., Payment Integrity Compass, EPSI, EPIC) and external sources (e.g., Medicare/Medicaid website).

  • Assess risk/exposure associated with various reimbursement structure options and develop models, reports and tactics to ensure compliance with contracted reimbursement structures.

  • Prepare and effectively present results to Payer Strategy & Operations leadership, and other key stakeholders, for review and strategic planning activities.

  • Maintain knowledge of industry trends, payer policies and protocols, and revenue cycle operations to support effective contract compliance activities.

  • Prepare routine reports and ad-hoc analyses as directed, with ability to accurately reflect actual vs. expected contract performance trends.

Qualifications

Education:

Bachelor’s Degree in Business Administration, Finance, Healthcare or related field required or equivalent experience preferred.

Experience:

  • Healthcare, insurance or related industry experience preferred. Strong background in financial healthcare reimbursement analysis is required, including an understanding of diagnosis and procedure coding, billing practices, and payment methodologies. Managed care knowledge preferred. Must be able to lead and coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines.

  • The nature and scope of this position is to be involved in all aspects of contracts from beginning to end, including the initiation, evaluation, negotiation, re-negotiation implementation, maintenance and termination of contracts

  • This position provides a critical liaison and negotiating arm for CHI hospitals and physicians, which as a profound impact on the organization

  • This position will serve all stakeholders through on-going educational and problem-solving support

  • Requires daily contact with senior management, physician, hospital staff, and managed care company leaders

  • Must handle adverse politically difficult situations, as managed care negotiations have a direct impact on individual physician incomes, along with directly impacting the financial performance of CHI

  • Outside meetings with physicians and senior executive from external payers is frequent

  • This person must take accountability for designated reimbursement modules and systems and must be proficient in readying, interpreting and formulating complex computer system rules

  • The nature and scope of this position is to be involved in all aspects of contracts from beginning to end, including the initiation, evaluation, negotiation, re-negotiation implementation, maintenance and termination of contracts

  • This position provides a critical liaison and negotiating arm for CHI hospitals and physicians, which has a profound impact on the organization

  • This position will serve all stakeholders through on-going education and problem-solving support

  • This position requires daily contact with senior management, physician, hospital staff, and managed care company leaders

  • The position must handle adverse and politically difficult situations, as managed care negotiations have a direct impact on individual physician incomes, along with directly impacting the financial performance of CHI

  • Outside meetings with physicians and senior executives from external payers is frequent

  • This person must take accountability for designated reimbursement modules and systems and must be proficient in reading, interpreting and formulating complex computer system rules

Job Professional Non-Clinical

Primary Location COLORADO-ENGLEWOOD-DENVER INVERNESS

Other Locations ARKANSAS-LITTLE ROCK, KENTUCKY-LOUISVILLE, KENTUCKY-LEXINGTON, TENNESSEE-CHATTANOOGA

Daily Schedule 1

Scheduled Hours per 2-week Pay Period 80

Weekends Required None

Req ID: 2018-R0147570