Payment Transformation Analyst

Job ID

68289

Location

Aurora, Colorado

Full/Part Time

Full-Time

Regular/Temporary

Regular

Why Work at Children's....

Here, it’s different. Come join us.

Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years.

Here, the nation’s brightest nurses, physicians, scientists, researchers, therapists and care providers are creating the future of child health. With an optimist’s outlook, a trailblazing spirit and a celebrated history, we’re making new strides every day.

We’ve been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the nation’s top 10 pediatric hospitals by U.S. News & World Report. 

As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 12 specialty care centers, 400 outreach clinics and 7,000 healthcare professionals representing the full spectrum of pediatric care specialties.

We need your expertise.

A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it’s different. Do you have what it takes?

Additional Information

Department: Decision Support

Hours per week: 40, eligible for benefits

Shift: M-F/40 hrs per week

Job Overview

The Payment Transformation Analyst provides technical and analytical support related to the evaluation, negotiation, implementation, maintenance and performance reporting of commercial and governmental payer contracts for CHCO, including our hospitals, network of care locations, employed physicians and non-physicians, and our clinically integrated network (CIN).  Provides detailed financial analysis of fee-for-service and value-based contracts, outcomes reporting, alternative payment models, and shared savings contracting to support Payer partnership initiatives. Develops financial models for maximizing reimbursement and market share and contributes to the development of new reimbursement/payment methodologies that are consistent with CHCO’s strategic plan. 

Responsibilities

POPULATION SPECIFIC CARE

No direct patient care.

ESSENTIAL FUNCTIONS

An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform.

Demonstrated knowledge of managed care concepts and the financial relationship between payers and providers.

Possesses strong analytic and technical skills and the ability to translate complicated data into useable knowledge.

In-depth knowledge and understanding of health care claims data, coding schemes (e.g., CPT, ICD9/10, OPPS, DRGs, etc.) and risk adjustment.

Knowledge and understanding of various types of contractual relationships and reimbursement methods between payers and providers for hospital, physician, and ancillary services, including global and bundled payments and risk-sharing arrangements.

Knowledge of managed care service operations (e.g., provider billing and claims processing) and terminology, such as premiums, PMPM, risk adjustment, case severity, benefit plan designs, medical cost ratio, cost controls, etc..

Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.

Ability to coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines.

Ability to compile, analyze, interpret, and present complex financial reports, statements, and/or projections.

Knowledge of Federal and State financial and managed care regulations.

Perform additional duties as assigned.

Other Information

SCOPE AND LEVEL

Guidelines: Developmental, standard, or intermediate level.  Guidelines are generally numerous, well established, and directly applicable to the work assignment.  Work assignment and desired results are explained by general oral or written instructions.

Complexity: Falls between the entry and full performance/senior level.  Duties assigned are generally repetitive and restricted in scope but may be of substantial intricacy.  Employee primarily applies standardized practices.

Decision Making: Decisions or recommendations on non-standardized situations are limited to relating organizational policies to specific cases.  Brings non routine issues to supervisor. Problems that are not covered by guidelines or that are without precedent are taken up with the supervisor.

Communications: Contacts with team members, clients or the public where explanatory or interpretive information is exchanged, gathered, or presented and some degree of discretion and judgment are required within the parameters of the job function.

Supervision Received: Under normal supervision, within a standardized work situation, the employee performs duties common to the line of work without close supervision or detailed instruction.  Work product is subject to continual review.

Qualifications

Education:  Bachelor’s degree in Finance, Accounting, Underwriting, Health Care or related field.

Experience:  Minimum 3 years of healthcare and/or payer financial analysis experience.

Equivalency:  In lieu of a Bachelor’s degree, one year of professional experience will serve as an equivalency to one year of education.

Physical Requirements

Ability to Perform Essential Functions of the Job

Audio-Visual: Far Vision: Good

Audio-Visual: Hearing: Good

Work Environment

Mental/Emotional: able to tolerate ambiguity

Mental/Emotional: able to prioritize effectively

Mental/Emotional: may be subject to many interruptions

Office Work Environment: Regular/frequent exposure

Bloodborne Pathogen Category 2: Occasional exposure to blood/body fluid

Equal Employment Opportunity

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation.  Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

Salary Information

Annual Salary Range (Based on 40 hours worked per week): $65,969.44 to $98,954.16

Hourly Salary Range: $31.72 to $47.57

Benefits Information

As a Children’s Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, 403b employer match (retirement savings), and a robust wellness program.

Salary : $32 - $48