The Sr. Healthcare Business Analyst performs a variety of duties to support the day-to-day activities required throughout the clinically integrated network (CIN) and other value-based initiatives to include Episodic Care Delivery, Business Process Outsourcing (BPO) and Group Purchasing Organization (GPO). The role is responsible for the delivery of financial, clinical, and provider utilization data to CIN leaders, Providers, Episodic Care Delivery and Payor Relations teams. Strong communication skills, critical analysis, and the ability to interact with people at all levels is required.
The role works in close collaboration with internal and external leaders and staff members, payors, and physicians to evaluate programs, services, and processes to improve the CIN's overall operational, clinical, and efficient performance. The position utilizes an understanding of clinically integrated networks (CIN) and other healthcare delivery models and works in a fast-paced dynamic environment.
The Sr. Healthcare Analyst must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, with significant attention to detail for completion of both verbal and written external communications.
Essential Duties and Responsibilities
- Financial modeling for payor contracts to include bundled payment contracts for episodes of care, specifically around internal cost structure, revenue potential, and shared savings opportunities.
- Payor FFS contract analysis and projections supporting payor contracting negotiation function
- Evaluates key performance metrics to support value-based contracts, quality measures, gap of care opportunities, patient engagement metrics, and other quality programs and initiatives.
- Evaluates managed care agreements and fee schedule analysis to provide recommendations to improve client revenue.
- Produces ongoing financial models to outline the cost of care for clinical networks based on utilization of Healthcare Services by patient population.
- Develop financial and operational planning models for new service offerings to determine optimal pricing and staffing structures.
- Evaluate new business opportunities, products, services, and growth initiatives by developing financial projection models.
- Prepare sensitivity analysis impact on revenue, expenses, and profitability by modeling changes in key variables (recommending appropriate course of action).
- Financial (IS/BS/CF) and operational modeling for the continued buildout of CIN and other value-based initiatives.
- Performs ad hoc analysis to provide clients margin analysis, staffing models, and budgeting.
- 5yrs+ Healthcare experience required; CIN or physician network preferred
- Demonstrated understanding of medical reimbursement methodology (ICD-10_CM Diagnosis, procedure (CPT) coding, and DRG payment system),
- Knowledge of healthcare revenue cycle and payor contracting to include commercial, government, workers’ comp and value-based payment models
- Proficient in computerized database management systems, statistical/analytics software (SAS, SQL, Alteryx, etc.) and Microsoft Office products (Access, Excel, PowerPoint, Word, Visio).
- Strong financial modeling, analytical and problem-solving skill
- Ability to manage multiple projects simultaneously in a fast-paced environment
- Ability to work with large amounts of data to develop scalable financial reporting solutions.
- Innovative thinker who generates creative solutions to problems
- Excellent interpersonal and communication skills, with ability to interact at all levels of the organization
- Bachelor’s Degree required; Master’s Degree preferred