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.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.