Assisting the Manager of Contract Modeling with onboarding new employees and coaching and mentoring analysts with contract variances, simulations or contract build issues.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
Performs quarterly contract reviews to ensure models are calculating accurate expected reimbursement. Prepares summary reports with corrective action plans.
Leads projects/initiatives requiring contract modeling and proposes recommendations for solutions and feedback to leadership.
Coaches and mentors Analysts and assist with troubleshooting contract variances.
Researches and resolves discrepancies between expected reimbursement and actual payments.
Reviews Analyst contract modeling simulations for accuracy and provide feedback on opportunities for improvement.
Independently create contract modeling simulations to evaluate reimbursement rate proposals to support the contract negotiations.
Escalates payer contract non-compliance issues to contract administrators.
Assists with payment validation requests.
Executes EPSI and basic SQL reporting for ad hoc requests.
Migrates team's updates to Production via Data courier.
Responsible for assisting Reimbursement with monthly accruals estimates.
EDUCATION/EXPERIENCE REQUIRED:
Bachelors Degree in Accounting, Finance, or a related field required. Masters Degree preferred.
Minimum 10 years of experience in healthcare industry.
Minimum five (5) years of experience in Payer Contract modeling.
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.
Proficient in Microsoft Word, Excel, and PowerPoint.
Willing to maintain flexible hours to support projects and workgroups.
Based on the needs of the Department this role will be supporting, this opportunity a best fit for someone with the following:
Advanced critical thinking and reasoning skills.
Self-Starter and ability to clearly document and communicate assumptions and processes.
Strong stakeholder engagement/ reporting skills.
Professional Rate Development experience.
Advanced Excel and actuarial/financial modeling & Data visualization.
Comprehensive knowledge of VBC analytics, trend analysis and KPI development (ACO model mechanics a plus).
Tableau/Power BI/Power Query, claims data interpretation.
Experience working with contract modeling systems (e.g., Epic contract modeling) across different types of payor arrangements.
SQL, SAS or Python/R, data engineering - big data skills.
Workflow mapping, data validation, feedback analysis experience.
Ability to independently build, validate, and interpret complex financial simulations to support contract negotiations, amendments, and performance forecasting.