Sr. Analyst, Strategic Pricing & Analytics
Remote
Company Overview: AMSURG is an independent leader in ambulatory surgery center services, operating a network of more than 250 surgery centers nationwide. In partnership with physicians and health systems, the organization delivers high-quality care for patients across a diverse spectrum of medical specialties, including gastroenterology, ophthalmology and orthopedics. To learn more about AMSURG, visit www.amsurg.com.
POSITION SUMMARY:
The Senior Analyst, Health Plan Relations will leverage 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, will interpret contract language, research payer and government fee schedules, and other various data quality and research initiatives. The candidate will coordinate communication between the AMSURG HPR team, the Business Operations (RCM) team and the Facility Operations team, along with analytical support to these and various 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: Remote
ESSENTIAL RESPONSIBILITIES:
- Supports 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
- Supports 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 negotiation
- Supports integration of reporting/visualization requirements and data into an analytics platform
- Manage, 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.
- Exceptional ability to 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.
- Analytical versality required to address a variety of ad-hoc analytical problems / requests that arise including ability to understand problem, independently define the right analytical approach and execute against the approach
- Strong organizational skills and ability to organize, manage and maintain HPR contract documents.
- Design, complete annual analysis to evaluate the impact of CMS fee schedule updates on AMSURG’s Medicare revenue to inform annual budget planning
- Ability to 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.
- Engage and support Business Operations department through reimbursement analysis and documentation to ensure contract compliance when post-implementation audits of payor’s Explanation of Benefits (EOBs) does not match expected pay rate.
- Display initiative to test and validate complicated reimbursement terms and troubleshoot pricing discrepancies with stakeholders and colleagues when needed.
- Meet or exceed all targets and deadlines.
- Regular and reliable attendance.
- Other duties as assigned.
QUALIFICATIONS:
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 to make recommendations to management regarding how to address highly complex problems.
- Ability to build financial and statistical models, analyze data, and translate analysis into specific, targeted actions to drive results
- Organized, detail oriented with excellent follow through abilities. Can handle and prioritize multiple tasks.
- Expertise in working with complex and large volumes of data including skills in some of the following applications SQL, Power BI, Tableau
- Ability to work in a fast paced and dynamic environment.
- Expertise in Microsoft Office applications with advanced Excel skills.
- Reliable, team-oriented, pleasant with excellent interpersonal skills.
- Relies on extensive experience and judgment to plan and accomplish goals.
- 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.
- Medical and insurance industry terminology.
- Must be 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 as approved in advance.
Education/Experience:
- Bachelor’s degree (or equivalent), preferred in business-related field or healthcare. Equivalent relevant experience will be accepted in lieu of a degree.
- Must have five years (5+), combination of managed care/payer rate modeling and/or managed care/payer contract negotiations.
- Experience rate modeling/analyzing various rate methodologies for ambulatory surgery centers, physician payments and/or anesthesia services is highly desired.
- Prior experience in reimbursement methodologies, revenue cycle, statistical modeling, financial reporting, contract management systems or data analytics.
Employment at AMSURG: Living Our Values Every Day
At AMSURG, our values define who we are and how we serve our patients, partners, and each other. As a national leader in ambulatory surgery, we are committed to a culture of excellence, integrity, teamwork and caring deeply. Our values guide every decision, ensuring we continue to elevate healthcare and provide the highest quality care.
These guiding principles are the foundation of our culture and a guide to how we collaborate, innovate, and make a difference every day.
- Care Deeply for those around us.
- Cultivate Integrity to build trust.
- Champion Excellence for continuous improvement
- Celebrate Teamwork every step to the way.
Benefits:
To ensure we retain and invest in great people, AMSURG provides its employees with the benefits, recognition, training, and opportunities needed for professional growth. Our wide range of health and welfare benefits allow you to choose the right coverage for you and your family. 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: Paid Time Off, 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.
EOE Statement:
AMSURG is an Equal Opportunity Employer (EOE). Qualified applicants are considered for employment without regard to age (40 or older), race, color, religion, gender, sex, national origin, pregnancy, sexual orientation, disability, genetic information or any other status protected under applicable federal, state, or local laws. We strive to also provide a disability inclusive application and interview process. If you are a candidate with a disability and require reasonable accommodation in order to submit an application, please contact us at: careers@amsurg.com. Please include your full name, the role you’re applying for and the accommodation necessary to assist you with the recruiting process.
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