- Supports the development and maintenance of tools for new and renewing provider reimbursement analysis through the use of internal membership, provider and claim databases
- Assists in implementation of vendor software for repricing claims using CMS reimbursement methodologies
- Subject matter expert and point person for ensuring updates to vendor software are implemented in modeling
- Creates and supports competitive positioning and benchmarking analysis
- Assists in measurement of provider cost and utilization performance for use in quarterly product pricing and annual budgeting/forecasting
- Manages and enhances large technical financial and statistical databases working in conjunction with other departments and IT as necessary
- Analyze and improve contracting value through identification and recommendations to create bundled reimbursements, from previous unbundled services
- Extensive knowledge in ICD, CPT, HCPCS, 3rd party payer requirements, federal and state guidelines and regulations pertaining to coding and billing practices
- Verifies and analyzes rate calculations submitted by hospitals and other providers for accuracy during the rate negotiation process
- Stays abreast on the latest reimbursement principals, governmental regulations and requirements (CMS, etc.)
- Responsible for the timely completion of external cost studies, prepares financial analysis filings and analysis on current and future reimbursement regulations
- Performs ad-hoc analysis and other job related duties as required
- Minimum of 5-7 years of progressive work experience in a health care analytics department setting (Healthcare Decision Support in managed care or hospital setting preferred)
- Ability to recognize opportunities for innovation in reporting and work product
- Ability to multi-task when faced with competing deadlines
- Advanced technical skills with minimum of three years writing new SQL/SAS scripts and running existing scripts
- Advanced Excel (pivot tables, V Lookups, macros etc.)
- Displays positive customer focus and able to work independently with deadline orientation
- Excellent analytical skills driven by a powerful inquisitiveness and curiosity about data
- Experience with database and large data set usage; including reporting, management and manipulation for analytical purposes
- Knowledge of healthcare financial analysis, trending, projections and analytic software models
- Participates in continual learning related to CMS and Commercial reimbursement methodologies
- Proficiency with innovating and developing new tools for end user's needs
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Senior Reimbursement Data Analyst - Springfield, United States - Health New England
Description
Job Description
Job DescriptionPurpose
The Senior Reimbursement Data Analyst prepares the financial and statistical analysis related to in/out-of-network providers within the Health New England's service areas. As a member of the Finance team, the Senior Reimbursement Data Analyst is responsible for building, supporting and ensuring data integrity in support of contract modeling. The position will serve as a partner with the Contracting Department and other HNE organizational departments. As an individual contributor, the Senior Reimbursement Data Analyst will possess strong quantitative, technical, analytic and interpersonal skills.
Job Responsibilities
A Bachelor's degree (MBA is preferred) in Finance, Accounting, Mathematics, Statistics, Actuarial, Data Science or related field.
