Senior Provider Network Pricing Analyst - Remote for Pacific / Hawaii Time Zones

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The Healthcare Economics Network Pricing Analyst supports and validates Provider Network (ACO's, physicians, hospitals, pharmacies, ancillary facilities, etc.) contracting and unit cost management activities through financial modeling, analysis of utilization, and reporting. This position located in the Western US Region conducts unit cost and contract valuation analysis in support of medical provider negotiations and cost management strategies. Responsibilities also include managing unit cost budgets, target setting, performance reporting, and associated financial models.

If you are located in the Pacific and Hawaii Time Zones, you will have the flexibility to work remotely as you take on some tough challenges.

• Perform unit cost and contract valuation analysis and reporting in support of network contracting negotiations and unit cost management strategies
• Analyze financial impact of corporate initiatives (e.g., policy changes; healthcare affordability) or external regulations (e.g., healthcare reform)
• Analyze payment appendices to provide options for various contracting approaches and methodologies
• Strategize rates or contract methodology with network management to create optimal contract
• Evaluate financial impacts of network configurations across hospital, ancillary and physician provider types
• Communicate results of financial impact and analysis to appropriate stakeholder groups (e.g., Network Management; Network Pricing leadership)
• Review competitive analysis to identify appropriate pricing rate for provider
• Utilize appropriate tools ( i.e., PPM, HPM, UCRT) to model and report impact of provider contracts
• Review charge master to ensure trending assumptions are correct
• Develop/maintain/update databases and tools needed to perform and support contract modeling
• Identify and investigate discrepancies (i.e., difference between actual allowed and modeled payment amount) in claim reimbursement
• Other duties as assigned by network pricing leadership
• This role may involve some external meetings, and light travel, to negotiate with providers, share performance results and explain complex financial models