Bachelor's Degree in Business Administration, Healthcare Administration, Finance, or related field
4-7 years of experience in business planning and analytics, particularly in Medicaid and managed care contracting
Master's degree in Business or Healthcare Administration preferred
Experience with FinThrive or similar contract management tools preferred
Advanced Excel modeling and automation skills, with extensive experience using Business Intelligence systems
Responsibilities
Lead complex analytics on Medicaid and Value Based contract proposals, evaluating financial impacts and making recommendations
Support contract negotiations with financial analyses that integrate multidisciplinary concepts
Maintain and implement automated reporting mechanisms for Medicaid and Managed Care business
Stay informed on Managed Care and Medicaid initiatives affecting funding and reimbursement
Provide analytics support for DPP and PSPP programs, collaborating with external entities as needed
Develop in-depth analytics and recommend improvements for efficiency
Prepare presentations for JOC and MOR, ensuring clarity and impact
Benefits
Opportunities for professional development and growth
Collaborative work environment with cross-functional teams
Engagement in impactful healthcare initiatives
Access to advanced analytics tools and resources
Supportive culture that values innovation and efficiency
Full Job Description
Description
Job Summary
The Sr Analyst Payer Contracting is responsible for financial modeling of all Commercial FFS and Value Based Managed Care and Managed Medicaid initiatives. Develops complex contractual financial analytics and models used during negotiations performed by Vice President of Population Health and Payer Strategy.
Job Specific Duties
Performs and leads complex analytics on Medicaid and Value Based contract proposals; evaluates financial impact and makes well thought out, logical recommendations.
Supports contract negotiations with financial analysis that ties together complex, multidisciplinary concepts impacting reimbursement.
Continuously maintains, creates, and implements automated reporting mechanisms to effectively manage Medicaid, Managed Care, and Value Based business by providing proactive trending/impact by key metrics and statistics.
Maintains engagement and awareness of Managed Care and Medicaid Industry related initiatives impacting funding and reimbursement to Children's Hospitals
Provides analytics support of DPP and PSPP programs. Works as needed with outside entities and consultants on development of analytics packages and reporting.
Develops and performs in depth analytics utilizing various tools and provides recommendations on streamlining and automation to improve efficiency
Supports in JOC and MOR presentation preparation.
Works cross functionally with Ensemble partners to ensure proper managed care contract loads and performance. Ensures rate updates are made timely and accurately. Develops reporting to audit expected payment calculations and identify contractual rate areas that need to be addressed.
Leads the development of the annual managed care net revenue budget package.
Develops/enhances managed care volume/net revenue trend analysis reporting suite to ensure timely access to relevant information needed by leadership.
Supports in Care Pricer estimator issues, transparency data needs, insurance plan code master changes, and all EPIC related items.
Develops/enhances/supports in Global package pricing development.
Increases utilization and integration of Turquoise price transparency tool into the Managed Care negotiation workflow.
Qualifications
Minimum Job Requirements
Bachelor's Degree in Business Administration, Healthcare Administration, Finance or related field
4-7 years of experience in business planning and analytics (Medicaid, managed care contracting, payer
analytics, strategic planning, business development, financial analysis, forecasting, and data modeling)
Knowledge, Skills, and Abilities
Master's degree in Business, Healthcare Administration, or related field preferred
Experience with FinThrive (previously known as MedAssets), or similar contract management tool system preferred
Experience working with EPIC a plus
Extensive experience using Business Intelligence systems
Advanced Excel modeling, formulas, and automation skills
Ability to manipulate large data sets and transform into usable and relevant information in support of strategic asks
Excellent verbal and written communication skills
Able to maintain confidentiality of sensitive information
Ability to problem solve and formulate a plan of action
Able to analyze and audit contracts; ability to understand the big picture and focus in on appropriate areas to model and assess financial impact
Strong ability to multitask and pivot as needed
Able to execute and follow through on tasks
Knowledge of reimbursement terminology and contract testing
Knowledge of all payer healthcare reimbursement methodologies (e.g., Government and non- government)
Demonstrates competency in financial and statistical reporting, design, preparation of spreadsheets and other financial reports
Strong problem-solving skills; open and adaptable to constructive criticism
Ability to work in high pressure/deadline driven environment.
Strong attention to detail and ability to tie overarching big picture strategy to detailed analytic approaches to test/prove/disprove hypothesis.
About Nicklaus Children's Health System
Nicklaus Children's Health System is a non-profit organization that provides pediatric care and services to children in South Florida. The organization was founded in 1950 and has since grown to become one of the largest pediatric healthcare systems in the region. Nicklaus Children's Health System is dedicated to providing high-quality, family-centered care to children of all ages, from newborns to young adults. The organization offers a wide range of services, including emergency care, surgery, rehabilitation, and more. Nicklaus Children's Health System is committed to advancing pediatric medicine through research and education, and is affiliated with several leading medical schools and research institutions.
