HybridHybrid position with onsite attendance required at the Williamsville location.
Finance & BankingRisk Management
No H1B Sponsorship
About the job
Requirements
A bachelor's degree is required, although an additional four years of experience may be substituted for the degree.
Three years of analytics experience, or an advanced degree plus two years of experience, is required; research and internship experience qualifies toward the latter.
Proficiency in Access, Excel, and analytical tools or programs such as SQL, SAS, and Microsoft Fabric is required.
Skill in statistical concepts, methodologies, and applications related to health care analytics and provider network management is required.
Extensive experience building and using statistically sound data-modeling support tools to conduct trend analysis and determine cost and utilization drivers is required.
Ability to define problems, collect data, establish facts, draw conclusions, transform data into actionable information, and clearly present results to upper management is required.
Attention to detail and skill in data-validation methodologies are required.
Ability to work collaboratively with other departments is required.
Verbal and written communication skills are required.
Examples of displaying the organization’s values—Passionate, Caring, Respectful, Trustworthy, Collaborative, and Accountable—are required.
Responsibilities
Analyze utilization, claims, membership, and cost data in support of the Network Contract Management department and corporate strategic initiatives.
Design and use analytical tools to draw statistically sound conclusions and present results to management.
Interpret and analyze data and recommend courses of action to management regarding fair, equitable, and market-competitive reimbursement that supports value for the health plan, provider partners, and members.
Design and conduct analyses using independent judgment, including making assumptions, identifying constraints, interpreting results, and making recommendations about the impact of reimbursement changes.
Conduct analysis and research to support provider contract negotiations, assess alternative reimbursement models, improve high-quality and high-value care, and assess the impact of policy changes, government mandates, consolidations, and mergers in the provider community.
After identifying a business need, independently design and conduct analyses; exercise sound judgment in developing analytical assumptions and constraints; interpret results; draw conclusions; and develop feasible alternative courses of action.
Present analytics results and recommend actions to management on business questions related to reimbursement and pricing.
Create analytical tools that support strategic initiatives and inform reimbursement and pricing decisions.
Apply understanding of reimbursement methodologies and underlying coding requirements, including DRG, CPT, and diagnosis codes, across provider networks and services.
Analyze provider networks, patterns and profiles, medical cost and utilization trends and drivers, and provider reimbursement and fee-change models.
Advise management and make recommendations concerning reimbursement and regulatory changes that may affect financial performance, interpreting the changes and applying subject-matter knowledge.
Participate in or lead analytics and research on alternative reimbursement and other initiatives by identifying, assessing, and interpreting the impact of alternative reimbursement methodologies in support of organizational strategy.
Assess impacts on policies and procedures and coordinate with multiple disciplines, staff, and management.
Document procedures, steps, results, and findings clearly.
Validate data and ensure report and information accuracy through quality-assurance methodologies and balancing procedures.
Participate in or lead corporate initiatives related to data warehousing, data integrity, new administrative platforms, and treatment-cost estimators.
Build trust and confidence in the appropriateness and accuracy of reports and analysis.
Collaborate with other analysts and seek input as needed.
Desired Qualifications
An MBA or equivalent advanced degree is preferred.
Experience in data analysis, statistical analysis, business modeling, or health care analytics or health informatics is preferred.
Understanding of the health care industry, health care economics, and hospital, physician, and ancillary reimbursement methodologies is preferred.
FIND YOUR FUTURE
We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.
Overview
The Provider Contracting & Reimbursement Analyst-Intermediate will analyze utilization, claims, membership, and cost data in support of the Network Contract Management department and corporate strategic initiatives. They will design and use analytical tools to draw statistically sound conclusions and present results to management.
The Analyst will interpret, analyze, and recommend courses of action to management as it relates to fair, equitable, and market competitive reimbursement designed to achieve value for the health plan, provider partners, and members. They will design and conduct analyses by applying independent judgment (e.g., making assumptions and identifying constraints of analyses), interpreting results, and making recommendations to management as it relates to assessing the impact of changes in reimbursement and representing hundreds of millions of dollars in annual expenditure.
Analysis and research will be designed to support provider contract negotiations, assess the impact of potential alternative reimbursement models, improve Independent Health’s ability to deliver high quality high value care, and provide management with the ability to assess the impact of policy changes, government mandates, consolidations, and mergers in the provider community.
Qualifications
Bachelor’s degree required. MBA or equivalent advanced degree preferred. An additional four (4) years of experience will be considered in lieu of degree.
Three (3) years of analytics experience OR an advanced degree plus two years of experience (research/internship experience qualifies) required.
Experience in data analysis, statistical analysis, business modeling or health care analytics/health informatics preferred.
Highly proficient in Access, Excel, and other analytical tools/programs (e.g., SQL, SAS, Microsoft Fabric).
Strong understanding of the health care industry, health care economics, hospital, physician, and ancillary reimbursement methodologies preferred.
Skilled in statistical concepts, methodologies, and applications related to health care analytics and provider network management.
Ability to frame questions that create value for business partners.
Extensive experience in building and using statistically sound data modeling support tools to conduct trend analysis and determine cost and utilization drivers.
Ability to define problems, collect data, establish facts, draw conclusions, transform data into actionable information and clearly present results to upper management.
Attention to detail and skilled at data validation methodologies.
Ability to work collaboratively with other departments.
Excellent verbal and written communication skills.
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
After identification of business need, independently design and conduct analyses by exercising sound judgment in approach and development of analytical assumptions and constraints, interpret results and draw conclusions, and develop feasible alternate courses of action.
Present results of analytics and make recommendations to management as it relates to business questions related to reimbursement and pricing.
Create analytical tools to support the organization’s strategic initiatives and utilize tools to inform reimbursement and pricing decisions.
Demonstrate understanding of reimbursement methodologies and underlying coding requirements (e.g., DRG, CPT, & diagnosis codes) as deployed across provider networks and services.
Conduct analyses of provider networks, patterns and profiles, medical cost and utilization trends and drivers, and provider reimbursement and fee change models.
Advise and make recommendations to management concerning reimbursement and regulatory changes that have the potential to impact on the organization’s financial performance by interpreting the changes and applying in depth knowledge of the subject matter.
Participate in or lead analytics and research associated with alternative reimbursement and other initiatives by identifying, assessing, and interpreting impact of alternate reimbursement methodologies to support the strategic direction of the organization. Assess impact on policies and procedures, coordinating with several different disciplines, staff, and management.
Document clearly all procedures/steps and results/findings.
Validate data, ensuring report/information accuracy through quality assurance methodologies and balancing procedures.
Participate in or lead corporate initiatives related to data warehousing, data integrity, new administrative platforms, and treatment cost estimators.
Build trust and confidence in appropriateness and accuracy of reports and analysis.
Collaborate with other analysts and seek input as needed.
This is a hybrid position with onsite attendance required at our Williamsville location.
Immigration or work visa sponsorship will not be provided for this position
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click herefor additional EEO/AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub.