Senior Payer Analytics Consultant

We have an opportunity to join the Alliance as a Senior Payer Analytics Consultant in the Payment Strategy Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Payment Strategy Director, this position:

• Performs complex managed care payer financial modeling and analysis to evaluate the feasibility of payer reimbursement methodologies
• Conducts complex financial analysis to support successful payer reimbursement outcomes
• Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives
• Provides subject matter expertise and assists with providing orientation, mentoring, and training to subordinate Payer Analytics Consultants

ABOUT THE TEAM

The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs.

THE IDEAL CANDIDATE

• An experienced analytical and collaborative professional, with direct experience with complex medical payor modeling
• Technically strong, with skill in provider reimbursement modeling, payment structure design and reimbursement strategies
• A collaborative and professional communication style, building productive relationships supporting multiple stakeholders
• Experience with Medicare and/or Medi-Cal (Medicaid) a plus

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of:
• Methods and techniques of financial modeling and analysis
• Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems
• Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers
• Various types of health insurance payers, including Medicare, Medicaid, and commercial plans
• Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider type
• Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), and ICD 9/10
• Ability to:
  • Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations
  • Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
  • Translate data into understandable information and deliver solutions that improve business processes
  • Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs
  • Assist with the orientation, training, and mentoring of other staff, as assigned
• Education and Experience:
  • Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, or a related field
  • Minimum of five years of experience performing financial healthcare reimbursement analysis (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

Originally posted on Himalayas