Job Description

Employment Status:
Full time
Job Function:
Business Professional
Department:
417852 Payor Analytics - Specialist
Shift Hours / Days:
Hours / Pay Period:

SR PRICING ANALYST

The Pricing Analyst has the responsibility of developing financial tools and models providing essential analytical support of CTCA payer and employer contracts.  Major areas of focus include financial modeling, decision support of contract negotiations, and operational reports focused on the modeling of contracts. This information will be used in the development of pricing strategies and contract negotiations across the CTCA system.

  • Develops contract valuation analysis of all implemented and proposed contracts, producing detailed analysis by categories of service, cost and utilization metrics, and to include the impact of charge master, case mix, and any adjustments to fee schedules.

  • Track contract performance against expectations, including highlighting areas of concern and provide notations of performance deviations and anomalies.Uses analysis to help identify opportunities for negotiations and optimize reimbursement.

  • Perform financial analysis in support of actual, budgeted, and projected cost analysis.

  • Responsible for the ongoing monitoring of key metrics and trends, comparing actual to budget.

  • Compile and maintain modeling summaries and volume trends for budget and pricing strategies.

  • Accurately interpret contract payment methodologies and provide feedback to other internal departments to ensure claims are reimbursed according to the intent of the negotiated reimbursement schedules.

  • Maintain a thorough knowledge of reimbursement methodologies, contractual terms, billing and other operational factors needed supporting negotiations and contract implementation.

  • Analyze various reimbursement methods and make recommendations supporting pricing strategies.

  • Creates and publishes periodic reports, as well as any necessary ad hoc reports.

Education/Experience:

  • Bachelor’s Degree required (Masters preferred) preferably in Economics, Finance, Mathematics, Statistics or a related field of study, although a high level of relevant experience or superior performance may substitute for the academic requirement.

  • Minimum of three years of experience in health care or managed care required, five years or more preferred.

  • Minimum of three years of health care financial data analysis required, five years or more preferred.

Knowledge and Skills:

  • Ability to analyze and interpret raw data from multiple sources and synthesize into clear and concise information from which specific conclusions can be drawn and appropriate actions taken.
  • Familiarity with various types and sources of health care information, including financial and patient-level data files.
  • Knowledge of claims payment and processes, procedures and guidelines, and CPT, HCPCS, ICD-10, DRG coding.
  • Knowledge of managed care/hospital and physician contract interpretations and reimbursement methodologies.
  • Knowledge of CMS prospective payment systems and reimbursement methodologies.
  • Advanced level of proficiency with Microsoft Office Product Suite (Excel, Access, Word and PowerPoint).
  • Experience with Tableau, QlikView, Business Objects, or other Business Intelligence software.
  • Experience with statistical analysis package and experience with Oracle SQL query writing, SAS, Visual Basic, R, other)
  • Demonstrates tactical and strategic critical thinking; including strong conceptual and analytical skills to develop creative solutions to complex problems.