Contracting Analytics Specialist, Full Time- Days

Join Uchicago Medicine as a Contracting Analytics Specialist in the Finance department. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area.  

The Contracting Analytics Specialist is responsible for building and modeling all third-party payer contract reimbursement terms including but not limited to Managed Care Commercial payers, Government programs (Medicare, IL Medicaid), Medicare Advantage payers and Medicaid MCO payers in UCM’s contract management systems or internally developed models. This includes interpretation of these analytical models – those currently in place, those proposed by UCM in negotiations with external parties, and those sent to us by external parties for consideration – for all system entities in order to meet UCM long term financial goals. The Contracting Analytics Specialist will be expected to serve as a managed care subject matter expert for hospital, physician, and other ancillary contract rate and language terms. The Specialist will run analyses to understand historical trends and future performance of existing and proposed contracts for the purposes of internal benchmarking and reporting, and will be called upon to run analyses related to changes in reimbursement for future state decision making, such as opening new facilities, switching site of care, or for new technology or services. The Specialist will also assist the VP, Payer Contracting & Strategy; Executive Director, Payer Contracting, Financial Analytics & Operations; or any of the Managers of Payer Contracting in contract negotiations as requested and applicable.

Job Functions

• Assists Analytics Manager with modeling and analyzing current, proposed, and final contract pricing terms for UCM hospitals, physicians, and ambulatory/ancillary providers to determine revenue and operating margin changes; includes fee for service financial terms for commercial and governmental payers, ACO models, shared savings/shared risk, capitation, bundled pricing, and percent of premium.

• Assists Analytics Manager with developing robust financial business analytics to determine operational impacts and reporting needs, especially with regard to managed care business and the goal of revenue optimization.

• Utilizes contract management system to inform rate analyses and performs regular maintenance and auditing of contract management rate calculations to check for variances to expected contract terms.

• Continued education on ever-changing reimbursement rules and policy updates both commercial and governmental that impact expected reimbursement and contract models and education of internal stakeholders on reimbursement terms, methodology and impacts as needed. Responsible for providing contract rate or language information to other teams across the organization in a formal or ad hoc setting.

• Aids in strategic pricing analysis to support payer rate parity and pricing transparency work including periodic market comparisons and surveillance.

• Works collaboratively to provide committee, EVP, and Board presentation materials on topics related to contract financial terms in support of VP of Payer Contracting & Strategy and CFO.

• Strong attention to detail and well organized. Communicates effectively both verbally and in writing.

• Interact effectively with colleagues in a variety of contexts and forums and contribute as a team player.

• Microsoft Office Suite advanced proficiency also required, particularly Excel and PowerPoint. Strong aptitude for learning additional software or systems as needed, particularly finance and revenue cycle applications.

• SQL database experience is highly desirable but not required.

• Tableau experience is highly desirable but not required.

• Current operations are supported with NThrive/FinThrive as our contract management and modeling tool; experience with this is highly desirable but not required. Familiarity and aptitude with some form of contract management and/or cost accounting systems for use in data gathering and model analysis highly desirable.

Required Qualifications

• Requires a Bachelor’s degree, preferably in finance or a related field. 
• Requires a minimum of three or more years of related health care experience in financial analysis and data models and a record of successfully completing similar duties, demonstrating considerable knowledge of health care organizations, operations, finance, and managed care. 
• Experience in multi-facility health system, large academic and community physician groups or clinically integrated network, large academic medical center or insurer environment highly desirable. 
• Detailed knowledge and experience with hospital and physician complex reimbursement methodologies including FFS and value-based care (VBC) risk reimbursement structures including Medicare and Medicaid. 
• Excellent understanding of general healthcare contract language and rate terms. Knowledge of physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws. Examples include: - Proficient understanding of MS-DRG, APC, EAPG, case rate, stoploss, carveout reimbursement methodologies - Proficient understanding of Revenue Code and CPT coding in a clinical/hospital/ASC/physician office setting - Proficient manage care contract rate interpretation skills.

Skills/Preferred Qualifications

• Requires the ability to develop insightful observations and recommendations for courses of action from the analysis of complex situations, and to relate those concepts clearly and effectively in both spoken and written form. Adapts well to rapid change and multiple, demanding priorities with excellent time and project management skills. 
• Ability to work effectively in an independent matter and collaboratively with cross functional teams to meet goals and improve organizational performance. 
• Excellent analytical and problem-solving skills, and demonstrates a high level of critical thinking in their analytic work. Requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case for a recommended course of action.
• Ability to understand and interpret federal regulations and policies, coding guidelines and reimbursement changes.
• Strong attention to detail and well organized. Communicates effectively both verbally and in writing. Interact effectively with colleagues in a variety of contexts and forums and contribute as a team player. Microsoft Office Suite advanced proficiency also required, particularly Excel and PowerPoint. 
• Strong aptitude for learning additional software or systems as needed, particularly finance and revenue cycle applications. 
• Current operations are supported with NThrive/FinThrive as our contract management and modeling tool; experience with this is highly desirable but not required. 
• Familiarity and aptitude with some form of contract management and/or cost accounting systems for use in data gathering and model analysis highly desirable.
• SQL experience strongly preferred 
• Be present and focus on addressing one patient at a time giving your full attention.
• Exercise patience and empathy at all times (put yourself in other's shoes).

Position Details

• Job Type/FTE: (1.00) Full  Time 
• Shift/Location: Days (8am-5pm) Flexible morning start time
• Unit: Finance 
• CBA Code:Non-Union