Senior Health Insurance Reimbursement Analyst

Purpose

The Senior Reimbursement Data Analyst prepares the financial and statistical analysis related to in/out-of-network providers within the Health New England’s service areas. As a member of the Finance team, the Senior Reimbursement Data Analyst is responsible for building, supporting and ensuring data integrity in support of contract modeling. The position will serve as a partner with the Contracting Department and other HNE organizational departments. As an individual contributor, the Senior Reimbursement Data Analyst will possess strong quantitative, technical, analytic and interpersonal skills.

Job Responsibilities

• Supports the development and maintenance of tools for new and renewing provider reimbursement analysis through the use of internal membership, provider and claim databases
• Assists in implementation of vendor software for repricing claims using CMS reimbursement methodologies
• Subject matter expert and point person for ensuring updates to vendor software are implemented in modeling
• Creates and supports competitive positioning and benchmarking analysis
• Assists in measurement of provider cost and utilization performance for use in quarterly product pricing and annual budgeting/forecasting
• Manages and enhances large technical financial and statistical databases working in conjunction with other departments and IT as necessary
• Analyze and improve contracting value through identification and recommendations to create bundled reimbursements, from previous unbundled services
• Extensive knowledge in ICD, CPT, HCPCS, 3rd party payer requirements, federal and state guidelines and regulations pertaining to coding and billing practices
• Verifies and analyzes rate calculations submitted by hospitals and other providers for accuracy during the rate negotiation process
• Stays abreast on the latest reimbursement principals, governmental regulations and requirements (CMS, etc.)
• Responsible for the timely completion of external cost studies, prepares financial analysis filings and analysis on current and future reimbursement regulations
• Performs ad-hoc analysis and other job related duties as required

Desired Qualifications

A Bachelor’s degree (MBA is preferred) in Finance, Accounting, Mathematics, Statistics, Actuarial, Data Science or related field.

• Minimum of 5-7 years of progressive work experience in a health care analytics department setting (Healthcare Decision Support in managed care or hospital setting preferred)
• Advanced technical skills with minimum of three years writing new SQL/SAS scripts and running existing scripts (Required)
• Ability to recognize opportunities for innovation in reporting and work product
• Ability to multi-task when faced with competing deadlines
• Advanced Excel (pivot tables, V Lookups, macros etc.)
• Displays positive customer focus and able to work independently with deadline orientation
• Excellent analytical skills driven by a powerful inquisitiveness and curiosity about data
• Experience with database and large data set usage; including reporting, management and manipulation for analytical purposes
• Knowledge of healthcare financial analysis, trending, projections and analytic software models
• Participates in continual learning related to CMS and Commercial reimbursement methodologies
• Proficiency with innovating and developing new tools for end user’s needs