Payor Contracting Sr. Financial Analyst/Full Time/Hybrid
🔍 Troy, Michigan
GENERAL SUMMARY:
Under supervision of Manager and / or Director, support the managed care contracting function by performing necessary financial analysis to evaluate payor (or health plan) contract performance and payor rate proposals during contract negotiations and throughout the contract year. This includes benchmarking to regional averages, comparing to Government fee schedules and analyzing existing healthcare (claims) data and reimbursement terms and payment methodologies; with the goal of driving necessary improvement in net revenue for the health system.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
1. Perform deep dive financial analysis to develop and evaluate rate proposals and evaluate health plans financial performance.
2. Monitor contract specific payor rates and identify opportunities for improvement.
3. Review rate sections of proposed contracts and amendments to ascertain that all necessary reimbursement terms are included, and rates are depicted as negotiated.
4. Prepare plan level volume and profitability reports routinely and update as needed.
5. Assume active role in implementation and maintenance of contract management and pricing systems.
6. Develop “what if” scenarios and models in Excel to quickly assess margin impact of changing various reimbursement components.
7. Validate inpatient and high dollar outpatient payments for various payors, including MA, Medicaid and Commercial.
8. Create prospective and retrospective analyses to assess payment discrepancies or opportunities for revenue capture.
9. Develop queries and reports to extract claims and payor data from dbase reporting tool.
10.Perform other duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's Degree in Business, Accounting, Healthcare or related field.
- Minimum of four (4) years in the Healthcare industry in Managed Care Contracting, Provider Relations, Provider Reimbursement or related professional capacity.
- Excellent analytical skills.
- Understanding of various product reimbursements (Medicaid, Medicare, Commercial).
- Highly Proficient in Microsoft Excel: Pivots, formulas, modeling, graphs, etc.
- Microsoft PowerPoint able to create or update PPT's. Skilled in EPSi , SQL, Clarity or other Data query reporting tools.
- Excellent oral and written communication and presentation skills.
- Excellent organizational skills and ability to manage multiple projects simultaneously.
- Excellent interpersonal skills and ability to develop effective working relationship with both internal and external customers.
- Familiarity with Healthcare EHR / Claim Systems (i.e. EPIC or similar), preferred.
- Understanding of legal, business, and insurance operations principles.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.