Sr Analyst Payer Analytics and Economics

Welcome to CHI Saint Joseph Medical Group a full service network of primary care services specializing in family internal geriatric and pediatric care serving 88 locations across central and Eastern Kentucky. CHI Saint Joseph Medical Group is dedicated to delivering customized care based on the unique needs of our patients and is recognized as a Best Place to Work in Kentucky for two years in a row (2023-2024). 

CHI Saint Joseph Health is part of CommonSpirit Health a non-profit Catholic health system dedicated to advancing health for all people. With approximately 175000 employees and 25000 physicians and advanced practice clinicians. 

Our commitment to serve the common good is delivered through the dedicated work of thousands of physicians advanced practice clinicians nurses and staff; through clinical excellence delivered across a system of 140 hospitals and more than 2200 care centers serving 24 states.

This Role is Remote but you Must live near Lexington for several in person meetings per year.

Job Summary / Purpose: The Senior Analyst, Payer Analytics & Economics performs complex managed care payer financial analysis, strategic pricing, and payer contract modeling activities for a defined payer portfolio. This role provides analytical and pricing expertise for evaluating, negotiating, implementing, and maintaining managed care contracts between CommonSpirit Health providers and payers. The position recommends strategies for maximizing reimbursement and market share and provides mentorship to Analyst contract modeling. Additionally, it provides analysis findings and education to key stakeholders and serves as a resource for ongoing educational and problem-solving support for managed care payer reimbursement models. This role requires daily interaction with senior management, physicians, hospital staff, and managed care/payer strategy leaders.

Essential Key Job Responsibilities:

• Payer Contract Modeling & Strategy:
  Lead payer contract modeling strategy and consolidation for large managed care payer negotiations. Act as a liaison between CommonSpirit Health and payers to update information and communicate changes related to reimbursement.

• Strategic Pricing Analysis:
  Perform complex strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language for managed care contracting initiatives. Develop and approve financial models and payer performance analysis.

• Contract Financial Performance Monitoring:
  Monitor and analyze contract financial performance, publish managed care performance statements, and determine profitability. Review and interpret contract terms, including payer policies and procedures impacting contract performance.

• Training & Oversight of Modeling:
  Provide training and oversight of the modeling of proposed/existing payer contracts, including expected and actual revenues/volumes, past performance, proposed contract language, and regulatory changes.

• Service Line Reimbursement & Financial Analysis:
  Prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and models to identify the implications of new/revised strategies aimed at establishing appropriate reimbursement levels.

• Data Collection & Analysis:
  Identify, collect, and manipulate data from a variety of internal and external sources (e.g., PIC, STAR, TSI, PCON, EPIC). Access and utilize appropriate data resources to support analyses and recommendations.

• Presentation to Senior Leadership:
  Prepare and effectively present results to senior leadership and key stakeholders for review and decision-making.

• Operational Knowledge & Reporting:
  Maintain knowledge of operations to identify causative factors, deviations, and allowances affecting reporting. Translate operational knowledge to identify trends or issues and project their impact proactively.

• Leadership & Training:
  Provide leadership, oversight, and training for Payer Analytics & Analyst contract modeling activities.

Additional Information: The job summary and responsibilities listed above indicate the general nature of the work performed. They are not designed to be a comprehensive inventory of all job responsibilities. Employees may be required to perform other duties as assigned.

Minimum Qualifications

Required Education and Experience:

• Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare, or a related field. Equivalent education and experience in a related field may be considered in lieu of a degree.
• Minimum of three (3) years of experience in financial healthcare reimbursement analysis, with a strong understanding of national standards for fee-for-service and value-based provider reimbursement methodologies.

Required Minimum Knowledge, Skills, Abilities, and Training:

• Working knowledge of financial healthcare reimbursement analysis, including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies.
• Experience contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.
• Basic technical understanding and proficiency in MS Excel, MS Access, MS Visual Basic, PIC, SQL, or other related applications.
• Working knowledge of healthcare financial statements and accounting principles.
• Ability to use and create data reports from health information systems, databases, or national payer websites (e.g., EPIC, EPSI, PIC, SQL Databases).
• Proficiency in reading, interpreting, and formulating computer and mathematical rules/formulas.