Payer Operations Analyst

Job Summary

The Payer Operations Analyst serves as lead support in system wide governmental and non- governmental payer performance analytics and negotiations, as well as other service line/operational/clinical/professional analytics. Utilizes various software, databases, BI/Data Visualization/Contract Modeling systems, and other applicable resources to meet or exceed objectives. Also works on cross functional initiatives with external collaborators/partners, as well as with internal teams, including but not limited to Finance, Decision Support, Strategy, Global Health, Revenue Cycle, Patient Access, Nicklaus Children's Pediatric Specialists LLC.

The Payer Operations Analyst serves as lead support in system wide governmental and non- governmental payer performance analytics and negotiations, as well as other service line/operational/clinical/professional analytics. Utilizes various software, databases, BI/Data Visualization/Contract Modeling systems, and other applicable resources to meet or exceed objectives. Also works on cross functional initiatives with external collaborators/partners, as well as with internal teams, including but not limited to Finance, Decision Support, Strategy, Global Health, Revenue Cycle, Patient Access, Nicklaus Children s Pediatric Specialists LLC.

• Supports in the development and implementation of current, and future state, commercial, and governmental payer analytics reports.
• Demonstrates expertise and leadership in performing/producing intricate financial analysis.
• Responsible for continuous learning and development understanding of Statewide/National managed care and Medicaid payer trends in order to round out ability to produce well thought out and relevant and proactive analysis, with accompanying recommendations/observations for leadership.
• Supports during managed care negotiations by ensuring proactive, timely and appropriate availability of all reporting and analytics for leadership.
• Responsible for timely update and dissemination of a variety of departmental matrices, including but not limited to payer hospital and employed physician rates/participation, charge master increases/notification, behavioral health rates/participation, DPP payment tracking, as well as payer policies, bulletins and updates.
• Responsible for production and coordination of reporting/analytics/research to support payer specific, system wide initiatives.
• Supports in yearly managed care budget analysis and preparation.

• Bachelor’s degree in Finance, Economics, Business Administration, Health Service Administration, or related field
• 3-5 years of progressive experience in financial and data analytics

• MBA or MHA preferred.
• Required experience working with contract modeling systems(e.g. Fin Thrive, Epic Contract Modeling)
• Strong analytical skills tied to an ability to understand and incorporate big picture ask in order to make appropriate, data driven recommendations
• Experience in data analytics related to health plans and/or hospital finance and strategy
• Background in Managed Care contracting on the provider or payer side a plus.
• Intermediate to advanced level of proficiency in Microsoft Office suite business Intelligence (BI) and data visualization platforms (eg Tableau)
• Ability to work in a high functioning environment with competing priorities and quick pivots without sacrificing quality of work product, all while maintaining a positive and welcoming attitude
• Self- starter; consistently demonstrate judgment and initiative in decision making. Possess effective problem solving skills grounded in independent research but supported by appropriate guidance
• Attention to detail, coupled with organization skills essential; timeliness and responsiveness to requests paramount
• Effective communicator across all levels of the organization

Accounting/Finance

NCHS-MANAGED CARE CONTRACTING-

Professional