Provider Payment Analyst II

Overview

Under the direction of the Provider Payment Strategy Manager, this position will support the development, evaluation, and advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including performance and alternative payment approaches, and advise executive-level leadership regarding the feasibility of various strategies. This position will require the utilization of a variety of methods, models, and data sources to evaluate potential reimbursement methodologies and rates, will provide organizational education related to Partnership’s network provider reimbursement, act as a subject matter expert, inform the development, maintenance, and implementation of business unit policies and procedures, and perform other duties as assigned.

▪ Supports the development, evaluation, and advancement of provider reimbursement methodologies to align with organizational strategies and objectives, including performance and alternative payment approaches, and advises executive leadership regarding the feasibility of various strategies and methodologies, with duties including but not limited to:

• Identifies strategies and tactics to advance provider payment methodologies, including supporting the Contracts team in language translation and development.
• Creates, models, and implements reimbursement strategies, including alternative payment and risk payment arrangements with hospitals, primary care and specialty physicians, skilled nursing facilities, and ancillary providers.
• Develops materials to inform executives regarding the pros and cons of various methodologies, associated risks, and the feasibility of implementation.
• Serves as a subject matter expert with comprehensive knowledge of provider network and payment methodologies across all services.
• Conducts complex research and analysis of various internal and external data sources to inform provider reimbursement decisions and strategies, including evaluations of financial impact and implications on network adequacy.
• Supports strategic analysis in the development of tactical implementation plans to achieve objectives identified by the Executive Leadership Team or Partnership Board.
• Ensures alignment of provider reimbursement strategies with Partnership mission, policies and procedures, revenue, and various state initiatives.
• Monitors reimbursement and policy changes and trends in healthcare market dynamics, both locally, statewide, and nationally, and provides recommendations related to applicability to Partnership.
• Collaborates with provider communities and internal stakeholders to provide value-added services to members and increase operational efficiencies within the Partnership organization.
• Assists with documentation preparation required for internal and external audits, as directed.
• Supports provider rate negotiation efforts to ensure alignment with organizational policy.
• Evaluates contracted rates, contract language relevant to reimbursement, and reimbursement methodologies and conducts research and data analysis to resolve questions related to rates, methodologies, Partnership policies and procedures, and Statutory directives as they pertain to reimbursement.
• Supports implementation of contracted rates and collaborative relationships with providers, the Contracting team, and all stakeholder business units, as appropriate.
• Provides analytical and pricing expertise to support Partnership’s negotiation, implementation, and maintenance of managed care contracts.
• Supports the drafting, evaluation, and negotiation of a wide variety of different payee contract language as approved by Partnership leadership and in collaboration with the Contracts team and relevant business units.
• Monitors, maintains, and ensures the accuracy of a repository of current contract rates, exceptions, and reimbursement methodologies.
• Tracks, evaluates, and collaborates to process provider rate requests and requests for Letters of Agreement in accordance with Finance leadership directives and Partnership policy.
• Educates internal stakeholders regarding analysis related to provider reimbursement.
• Communicates activities and/or…