Senior Reimbursement Data Analyst

Job Description

Purpose

The Senior Reimbursement Data Analyst prepares the financial and statistical analysis related to in/out-of-network providers within the Health New England’s service areas. As a member of the Finance team, the Senior Reimbursement Data Analyst is responsible for building, supporting and ensuring data integrity in support of contract modeling. The position will serve as a partner with the Contracting Department and other HNE organizational departments. As an individual contributor, the Senior Reimbursement Data Analyst will possess strong quantitative, technical, analytic and interpersonal skills.

Job Responsibilities

Supports the development and maintenance of tools for new and renewing provider reimbursement analysis through the use of internal membership, provider and claim databases

Assists in implementation of vendor software for repricing claims using CMS reimbursement methodologies

Subject matter expert and point person for ensuring updates to vendor software are implemented in modeling

Creates and supports competitive positioning and benchmarking analysis

Assists in measurement of provider cost and utilization performance for use in quarterly product pricing and annual budgeting/forecasting

Manages and enhances large technical financial and statistical databases working in conjunction with other departments and IT as necessary

Analyze and improve contracting value through identification and recommendations to create bundled reimbursements, from previous unbundled services

Extensive knowledge in ICD, CPT, HCPCS, 3rd party payer requirements, federal and state guidelines and regulations pertaining to coding and billing practices

Verifies and analyzes rate calculations submitted by hospitals and other providers for accuracy during the rate negotiation process

Stays abreast on the latest reimbursement principals, governmental regulations and requirements (CMS, etc.)

Responsible for the timely completion of external cost studies, prepares financial analysis filings and analysis on current and future reimbursement regulations

Performs ad-hoc analysis and other job related duties as required

A Bachelor’s degree (MBA is preferred) in Finance, Accounting, Mathematics, Statistics, Actuarial, Data Science or related field.

Minimum of 5-7 years of progressive work experience in a health care analytics department setting (Healthcare Decision Support in managed care or hospital setting preferred)

Ability to recognize opportunities for innovation in reporting and work product

Ability to multi-task when faced with competing deadlines

Advanced technical skills with minimum of three years writing new SQL/SAS scripts and running existing scripts

Advanced Excel (pivot tables, V Lookups, macros etc.)

Displays positive customer focus and able to work independently with deadline orientation

Excellent analytical skills driven by a powerful inquisitiveness and curiosity about data

Experience with database and large data set usage; including reporting, management and manipulation for analytical purposes

Knowledge of healthcare financial analysis, trending, projections and analytic software models

Participates in continual learning related to CMS and Commercial reimbursement methodologies

Proficiency with innovating and developing new tools for end user’s needs

Full-time