Payer Operations Analyst

Job Summary

The Payer Operations Analyst serves as lead support in system wide governmental and non- governmental payer performance analytics and negotiations, as well as other service line/operational/clinical/professional analytics. Utilizes various software, databases, BI/Data Visualization/Contract Modeling systems, and other applicable resources to meet or exceed objectives. Also works on cross functional initiatives with external collaborators/partners, as well as with internal teams, including but not limited to Finance, Decision Support, Strategy, Global Health, Revenue Cycle, Patient Access, Nicklaus Children's Pediatric Specialists LLC.

Job Specific Duties

• Supports in the development and implementation of current, and future state, commercial, and governmental payer analytics reports.
• Demonstrates expertise and leadership in performing/producing intricate financial analysis.
• Responsible for continuous learning and development understanding of Statewide/National managed care and Medicaid payer trends in order to round out ability to produce well thought out and relevant and proactive analysis, with accompanying recommendations/observations for leadership.
• Supports during managed care negotiations by ensuring proactive, timely and appropriate availability of all reporting and analytics for leadership.
• Responsible for timely update and dissemination of a variety of departmental matrices, including but not limited to payer hospital and employed physician rates/participation, charge master increases/notification, behavioral health rates/participation, DPP payment tracking, as well as payer policies, bulletins and updates.
• Responsible for production and coordination of reporting/analytics/research to support payer specific, system wide initiatives.
• Supports in yearly managed care budget analysis and preparation.

Minimum Job Requirements

• Bachelor’s degree in Finance, Economics, Business Administration, Health Service Administration, or related field
• 3-5 years of progressive experience in financial and data analytics

Knowledge, Skills, and Abilities

• MBA or MHA preferred.
• Required experience working with contract modeling systems(e.g. FinThrive, Epic Contract Modeling)
• Strong analytical skills tied to an ability to understand and incorporate big picture ask in order to make appropriate, data driven recommendations
• Experience in data analytics related to health plans and/or hospital finance and strategy
• Background in Managed Care contracting on the provider or payer side a plus.
• Intermediate to advanced level of proficiency in Microsoft Office suite business Intelligence (BI) and data visualization platforms (eg Tableau)
• Ability to work in a high functioning environment with competing priorities and quick pivots without sacrificing quality of work product, all while maintaining a positive and welcoming attitude
• Self- starter; consistently demonstrate judgment and initiative in decision making. Possess effective problem solving skills grounded in independent research but supported by appropriate guidance
• Attention to detail, coupled with organization skills essential; timeliness and responsiveness to requests paramount
• Effective communicator across all levels of the organization