- Provide analytic support for network performance, unit cost trend, network profiling and evaluation, and contract modeling for current health plans, future business, and new products.
- Utilize applications and tools to support network performance management reporting and analytic needs.
- Support the design and development of applications to project and determine financial impact for contract negotiations for health plans, national contracting opportunities (hospital, physician, and ancillary) and impact of statewide rate changes.
- Support the design and development of enhanced analytic capabilities and tools to monitor and evaluate financial impact of changes in reimbursement terms with providers and statewide rate changes for health plans.
- Prepare network performance management reports to monitor and measure unit cost trends and network improvement opportunities.
- Identify, define, and implement improvements in the methods, standards and processes to better enable constructing enterprise and stand-alone applications.
- Identify and quantify cost of care savings opportunities, recommend strategies to achieve targeted results, and provide analytic support for health plans.
- Identify potential source data enhancements and business rule changes needed to produce the business information expected as a result.
- Research trends in provider reimbursement and strategy to improve unit cost performance.
- Evaluate alternative reimbursement methodologies to improve unit cost management for current and future business opportunities.
- Collaborate with health plans to evaluate analytic needs for contracting modeling and evaluation to support contract negotiations
- Support existing application solutions, develop enhancements requested by the business, and identify technical enhancements to improve stability, performance and quality of the outcome.
- Bachelor's degree in Business, Finance, Accounting, related field, or equivalent experience.
- 4+ years experience with provider reimbursement and analysis, application development, data/contract analysis and data mining or statistics, preferably in the healthcare industry.
- Intermediate knowledge of Access and Excel applications.
- Working knowledge of SQL tools, analytical software (SAS, SPSS, etc), and Business Objects/Cognos preferred.
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