The Contracting Analyst reports to the Director, Contract Analytics and Modeling. Under general supervision, produces financial and statistical reports and analytics. Assists in the establishment of appropriate contract rates and reimbursement structures and evaluates existing contract performance as well as forecasting impact of proposed contract rates.
Builds and maintains payer contract models in the contract management tool. Designs and prepares accurate, timely and actionable analyses, financial models, dashboards and reports that effectively support payer contract negotiations and payer relations strategies and decision-making. Conducts research and generates analytics to evaluate the drivers of key trends that impact contract margin performance, synthesize findings and identify risks and opportunities.
Implements and validates payer contract model terms, including the assessment of payment variances for revenue optimization. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done.
The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate
Conducts in-depth reviews and analysis on the cost and utilization of contracts. Provides financial analysis to support contract negotiations and compliance, including fee-for service, bundled payments, shared savings, and capitated contracts. Completes annual reconciliations and settlements.
Identifies and isolates problems/potential problems, issues and areas for financial improvements. Recommends and implements necessary changes. Develops financial strategies, plans and forecasts for all fee-for-service and alternative payment models.
Develops computer models and reports for tracking and evaluating performance of contracts, including risk-based contracts. Assists in the planning and development of negotiation scenarios, i.e., modeling various payment alternatives. Works with payer representatives to solve problems, issues.
Maintains effective relationships with the clinical and physician leaders, IPAs and Health Plans, system affiliates, Corporate Services Finance Department, plan representatives and Contract Managers. Maintains departmental database to track financial performance of contracts. Oversees contract reporting and quarterly performance reports.
Prepares financial and statistical reports. Prepares and distributes affiliate contract financial reports. Prepares simulation models and financial Executive summaries.
Functions as the finance liaison with health plan representatives. Leads finance and/or reporting teams of various contracts. Participates in team/staff meetings.
Participates in councils and other such committees as required. Provides value-added analytic support in the development and monitoring of standard and ad hoc cost and utilization reporting. Identifies and understands the trends and patterns of utilization and evaluates clinical/medical management programs and initiatives.
Performs complex analyses. Interprets trends, regulatory changes, and/or forecasts, and anticipates impact for members. Participates in the development and ongoing enhancement of revenue, cost and utilization reporting to meet the needs of medical managers as well as business and finance managers.
Analyzes and interprets cost utilization information; identifies key drivers and underlying issues; performs appropriate drill down queries; summarizes and present findings and opportunities. Works with member/client to implement identified opportunities and make recommendations to management and members and provide guidance in selecting alternatives for costs savings and efficiency. Leads the development of contracting reports, analysis and financial reconciliations required to understand the key drivers of the relevant business unit or service line.
Helps to develop the systems and processes that are the foundation for reporting and analysis. Participates as a content expert in key forums and meetings with Senior Leaders, Directors, Managers, Medical Directors and other Executives. Designs and creates charts, graphs, tables and reports to support findings and develop recommendations.
Supports evaluation of new and existing business opportunities through scenario modeling and financial analysis. Provides input for budget/forecast revenue and cost projections. Provides input for profitability projections and pricing strategy.
Identifies and reports quality risks related to contract reporting. Ensures that related information is obtained, documented in detail, tracked and available for access and quality review. Works closely with the Central Business Office, Strategic Business Planning, Reimbursement/DSDS, Managed Care Contracting and Utilization Management departments to identify revenue and cost savings opportunities, support new product and business development, regulatory compliance, contract negotiations and reconciliation of incentive arrangements with other payers and vendors.
Drives the development of appropriate program metrics and outcomes during the design phase of new clinical programs with an understanding of available and reliable data. Develops data queries; conducts rigorous analyses using appropriate statistical methods; interprets results and presents findings to leadership. Collaborates with outside program vendors in analyzing and interpreting outcomes of vended programs.
Quantifies the impact of clinical initiatives on overall medical expenses and trends and works with finance and budget staff to incorporate into the appropriate financial and budget reporting. Develops and maintains strategic pricing model to produce various pricing scenarios using core variables (current price, market, cost, fee schedules, and Payor mix). Provides analytics to support the development of rational strategic and defensible pricing strategy recommendations and coordinates annual strategic pricing review.
Recommendations will be based on assessment of charge structure compared to peer hospitals, internal cost accounting data, and claims level data. Analyzes chargemaster accuracy in accordance with regulatory requirements, compliance requirements, and appropriateness of bundling/unbundling. Develops processes and analyzes day-to-day charge master pricing requests and works with PFS to implement related changes.
Reviews annually the CPT/HCPCS codes and revenue code updates. Creates ad hoc pricing reports summarizing benchmarking, cost, and revenue data. Performs other related duties as required.
BASIC KNOWLEDGE: Bachelor's Degree in Business, Finance, Health Administration or related field.
Four to six years of experience in healthcare with a heavy emphasis in one of the following areas: reimbursement, contracting, financial analysis or forecasting. Strong understanding of provider reimbursement methodologies and managed care programs and contracts. Strong analytical skills, including the ability to understand complex concepts, develop analyses that are responsive to business needs, and summarize relevant findings in a clear, concise manner.
Highly proficient in Microsoft Office, specifically MS Excel, Access and PowerPoint. Experience in Allscripts EPSi decision support tool preferred. Highly organized with strong project management skills, including the ability to meet deadlines, effectively communicate with all levels of the organization, and work as part of a team.
Work is performed in a typical office setting.
$67,724.80-$111,716.80 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location: Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903 Work Type: M-F 8am-4:30pm (Flexible Times) Work
Day Daily Hours: 8 hours Driving Required: No