Payor Contract Reimbursement Analyst

Location: WellSpan Health, York, PA

Schedule: Full Time

Sign-On Bonus Eligible

Remote/Hybrid

Regular

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Hours

Monday through Friday, 8am-5pm

General Summary

Performs a variety of payment/financial analysis and financial reports for all System entities. Assures payor compliance with contract financial terms. Performs a wide variety of fiscal analysis and contracting recommendations in support of Payor Contracting and Population Health Finance. Provides financial support of contracted payor reimbursement, which include, but are not limited to, financial analysis, payor performance reporting, development of other fiscal management processes to support Payor Contracting and Population Health's portion of System's continuous pursuit of its Mission. Works independently and exercises independent judgment and discretion.

Duties and Responsibilities

Remote Work Capable

Essential Functions:

• Prepares and analyzes various data reports in support of payor negotiation for all System entities (Hospitals, Medical Groups, VNA, WellSpan Pharmacy, WME and Apple Hill Surgery Center).

• Prepares and analyzes the financial impact for specialty services, specialty pricing/bundles, and entities, such as Hospitals, Medical Groups, Ancillaries and Dental Center.

• Prepares, analyzes, and maintains payor performance reports/yield and payor scoring reports for all System entities and identifies opportunities for improvement.

• Develops predictive modeling in support of payor negotiation for all System entities.

• Prepares annual budget forecasting and modeling support for all System entities.

• Supports System compliance with contract notification terms, such as, annual price increases and changes in service.

• In conjunction with Vice President of Payor Contracting & Population Health, prepares analysis for unique reimbursement methodologies for specialized payor contracts.

• Supports professional and collaborative relationships with Payors and team members.

• Provides ad-hoc financial and negotiation analysis and reports to System management as requested.

• In conjunction with operational staff, analyzes financial impact of contract reimbursement, policy, or language changes/initiatives.

• In conjunction with Director of Payor Contracting, assures that proposed, new and/or changed contractual programs are attainable within the organization, the contract language accurately memorializes the agreed upon terms and appropriate WellSpan Health personnel is educated on the new or changed programs.

• Maintains knowledge of industry accepted contractual arrangements, financial opportunities, operational challenges, and other payor initiatives, including but not limited to State and Federal MCO regulatory programs.

• Participates in the strategic improvement of payor contracts as part of the Contract Integration Team and at times with Chief Clinical Directors, Directors of Quality, Administrative Vice Presidents, Quality and Clinical Improvement Managers, Ancillary and Hospital Leadership and Payors.

• Analyzes performance programs such as Arches, Foundations, Restorative Pain Management, Hospital at Home, bundle payment opportunity and any new requests.

• Validates and reconciles payor reporting, Cost and Utilization reporting, and internal dashboards.

• Utilizes Behavioral Health and Pharmacy Analytics to support negotiations.

• Assists with reporting requests for all Deloitte model updates.

• Performs proactive operational payor reporting - payor policy impacts via financial analytics tools.

• Supports, updates, and maintains Payor Scorecard.

• Supports, updates, and maintains Competitive Pricing Tool.

Common Expectations:

• Continuously assesses Payor performance and yield. Maintains appropriate quality control/assessment programs (if applicable).

• Enhances professional growth and development through participation in educational programs, current literature in-service meetings, and workshops.

• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation. Works well in teams.

• Participates in and continuously assesses and improves the department/service line/entity/System's performance.

• Presents strong presentation skills.

Required for All Jobs:

• Performs other related duties as identified.

• WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.

• WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Physical Demands:

• Standing - Occasionally

• Walking - Occasionally

• Sitting - Frequently

• Reaching - Rarely

• Talking - Frequently

• Hearing - Frequently

• Repetitive Motions - Occasionally

• Eye/Hand/Foot Coordination - Occasionally

Travel Requirements:

• Estimated Amount: 10% - Local and regional travel

Qualifications

Minimum Education:

• Associates Degree Required

• Bachelors Degree Finance, Accounting, Management and/or Health Care Administration Preferred

Work Experience:

• 3 years Working knowledge of Health System Revenue Cycle operations and payment methodologies and overall understanding of various aspects of health care financing. Required

• 3 years Healthcare reimbursement, third party payor negotiation/operations or regulatory experience, EPIC reporting, Power BI Preferred

Courses and Training:

• Finance, Data Analysis, Contract Negotiation Upon Hire Required

Knowledge, Skills, and Abilities:

• Excellent written and oral communication skills.

• Interpersonal and computer skills.

• Analytical, negotiation, and project management skills.

• Able to work well in a team.

• Strong Microsoft Excel experience.

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You’re unique and you belong here.

At WellSpan Health, we are committed to treating all applicants fairly and equitably, regardless of their job classification. If you require assistance or accommodation due to a disability, please reach out to us via email atemployment@wellspan.org. We will evaluate requests for accommodation on a case-by-case basis. Please note that we will only respond to inquiries related to reasonable accommodation from this email address. Rest assured, all requests for assistance or accommodation are handled confidentially, allowing applicants to share their needs openly and honestly with us.

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.