Senior Analyst, Strategic Pricing & Analysis – Health Plan Contract Management
Remote
AMSURG is a nationally recognized leader in the strategic and operational management of ambulatory surgery centers with medical specialties ranging from gastroenterology to ophthalmology and orthopedics. With more than 250 surgery centers across the U.S., we partner with physicians and health systems to deliver the highest standards of patient care and quality. For more information, please access our website: https://www.amsurg.com/.
Through AMSURG, our clinician-led organization is changing the face of healthcare by delivering high-quality care that puts the patient first.
Benefits:
At AMSURG, we offer benefits at the speed of your life. Our wide range of health and welfare benefits allow you to choose the right coverage for you and your family. Qualifying employees are eligible to enroll on the 1st of the month, following 30 days of employment. AMSURG offers a variety of health and welfare benefit options to help protect your health and promote your wellbeing. Benefits offered include but are not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA, Limited Healthcare FSA, FSAs for Transportation and Parking & HSAs, and a matching 401(K) Plan.
Paid Time Off:
AMSURG offers paid time off, 9 observed holidays, and paid family leave. You accrue Paid Time Off (PTO) each pay period and depending on your position and can earn a minimum of 20 days and up to 25 days per calendar year.
POSITION SUMMARY:
The Senior Analyst, Strategic Pricing & Analysis on our Health Plan Relations . Managed Care team leverages large, complex data sets to support the preparation, execution, and delivery of extensive financial analyses and models of proposed contracted rates for payer negotiations. In addition, this role will collect, load and analyze Health Plan Relations (HPR) contract information into the AMSURG Contract Database, interpret contract language, research payer and government fee schedules, and other various data quality and research initiatives. The Sr. Analyst will coordinate communication between the AMSURG HPR team, the Business Operations (RCM) team and the Facility Operations team, along with providing analytical support to these and other departments. This position directly impacts AMSURG’s financial statements as the contract terms and calculations are relied upon to estimate net accounts receivable.
Work Schedule: This role is offered on a fully remote basis allowing our Senior Analyst, Strategic Pricing & Analysis to be based anywhere in the country.
ESSENTIAL RESPONSIBILITIES:
- Support the preparation, execution, and delivery of extensive financial analyses and models of proposed contracted rates for payer negotiations, using a variety of business intelligence tools and platforms, inclusive of MS Excel, SQL, Power BI, and Tableau reporting.
- Support the coordination with various Business Intelligence and Data Integration teams to ensure consistent, comprehensive enterprise-wide data sets for use in the analysis of managed care contract negotiations.
- Support integration of reporting/visualization requirements and data into an analytics platform.
- Manage the complete analysis of large, complex data sets.
- Review, interpret, and analyze managed care contracts, and update database(s) by entering new and updated information and ensuring data quality, validity, and utility.
- Effectively coordinate and communicate within the AMSURG HPR team and cross-functionally with Business Operations (RCM), Operations and Finance Departments to ensure timely communication of managed care data / general information and implementation of HPR team’s overarching strategy.
- Refresh, review/quality check, and maintain existing analytic reports to ensure data is current and accurate.
- Oversee and assist in the design, development, and implementation of analytic ad hoc reports.
- Design and complete annual analysis to evaluate the impact of CMS fee schedule updates on AMSURG’s Medicare revenue to inform annual budget planning.
- Analyze impact of new fee schedules / payer groupers on reimbursement at the CPT code level as well as in aggregate based on AMSURG business needs.
- Research, analyze, organize, and maintain various Payer Fee schedules and Grouper crosswalks.
- Perform reimbursement analysis using various analytic tools for special departmental projects as needed.
- Adhere to all company policies and procedures, including Information Security Policies and ensure that AMSURG remains as secure as possible.
- Regular and reliable attendance is required.
- Other duties as assigned.
KNOWLEDGE AND SKILLS:
To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required:
- Excellent communication skills both on the telephone and in person. Ability to read general business information. Ability to compose general correspondence. Ability to effectively present information to all levels of an organization and respond to questions from all levels of contact.
- Strong critical thinking and problem solving skills enabling the individual to address moderate to highly complex problems without supervision and make recommendations to management regarding how to address them.
- Organized and detail oriented with excellent follow through ability.
- Able to handle and prioritize multiple tasks while working in a fast paced and dynamic environment.
- Reliable, team-oriented and pleasant, with excellent interpersonal skills.
- Relies on extensive experience and judgment to plan and accomplish goals.
- Able to exercise good judgment and positively influence others, including handling confrontations with poise and efficiency.
- Based on business need, the ability to work a flexible schedule including some evenings (and weekends on rare occasions).
Education/Experience:
- Bachelor’s degree from an accredited four-year college or university preferred in a business-related field or in healthcare and 5+ years’ relevant working experience; equivalent relevant experience will be accepted in lieu of a degree.
- Minimum of 5+ years working in a combination of managed care / payer contract negotiations / contract management and/or managed care / payer rate modeling.
- Experience building financial and statistical models, analyzing data, and translating analysis into specific, targeted actions that drive results.
- Experience in reimbursement methodologies (including Medicare/Medicaid and other government payors), revenue cycle, statistical modeling, financial reporting, contract management systems and/or data analytics.
- Experience rate modeling and analyzing rate methodologies for outpatient surgery (including ambulatory surgery centers), physician payments, and/or anesthesia services.
- Experience with the rules/regulations of Medicare/Medicaid and other government payors as well as commercial insurers and specialty contracts, to ensure accurate and timely billing and payment of claims.
- Expertise with Microsoft Office applications, with advanced Excel skills including working with VLookUps and complex formulas.
- Demonstrated expertise with complex and large volumes of data using business intelligence tools and platforms, i.e., SQL, Power BI, and Tableau reporting.
We are an Equal Opportunity Employer.
We do not discriminate in practices or employment opportunities on the basis of an individual's race, color, national or ethnic origin, religion, age, sex, gender, sexual orientation, marital status, veteran status, disability, or any other prohibited category set forth in federal or state regulations. Must pass a background check and drug screen.
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