Payor Contract Reimbursement Analyst - Payor Contracting - Day
About the position The Payor Contract Reimbursement Analyst at WellSpan Health is responsible for performing financial analysis and reporting to ensure compliance with payor contracts across various system entities. This role supports payor negotiations and population health finance by analyzing financial impacts, preparing performance reports, and developing predictive models. The analyst works independently, exercising judgment to provide financial support and recommendations that align with the organization's mission. Responsibilities • Prepares and analyzes various data reports in support of payor negotiation for all System entities. • Prepares and analyzes the financial impact for specialty services, specialty pricing/bundles, and entities such as Hospitals and Medical Groups. • Prepares, analyzes, and maintains payor performance reports/yield and payor scoring reports for all System entities and identifies opportunities for improvement. • Develops predictive modeling in support of payor negotiation for all System entities. • Prepares annual budget forecasting and modeling support for all System entities. • Supports System compliance with contract notification terms, such as annual price increases and changes in service. • Prepares analysis for unique reimbursement methodologies for specialized payor contracts in conjunction with the Vice President of Payor Contracting & Population Health. • Supports professional and collaborative relationships with Payors and team members. • Provides ad-hoc financial and negotiation analysis and reports to System management as requested. • Analyzes financial impact of contract reimbursement, policy, or language changes/initiatives in conjunction with operational staff. • Assures that proposed, new and/or changed contractual programs are attainable within the organization and accurately memorialize the agreed upon terms. • Maintains knowledge of industry accepted contractual arrangements, financial opportunities, operational challenges, and other payor initiatives. • Participates in the strategic improvement of payor contracts as part of the Contract Integration Team. • Analyzes performance programs such as Arches, Foundations, and bundle payment opportunities. • Validates and reconciles payor reporting, Cost and Utilization reporting, and internal dashboards. • Utilizes Behavioral Health and Pharmacy Analytics to support negotiations. • Assists with reporting requests for all Deloitte model updates. • Performs proactive operational payor reporting - payor policy impacts via financial analytics tools. • Supports, updates, and maintains Payor Scorecard and Competitive Pricing Tool. Requirements • Associates Degree Required; Bachelor's Degree in Finance, Accounting, Management, and/or Health Care Administration Preferred. • 3 years of working knowledge of Health System Revenue Cycle operations and payment methodologies. • 3 years of healthcare reimbursement, third party payor negotiation/operations or regulatory experience, EPIC reporting, Power BI Preferred. • Advanced Excel Skills (Pivot Tables, Advanced Formulas). • Critical thinking skills. Nice-to-haves • Experience in healthcare reimbursement and third-party payor negotiation/operations. • Knowledge of regulatory experience and EPIC reporting. Benefits • Comprehensive health benefits • Flexible spending and health savings accounts • Retirement savings plan • Paid time off (PTO) • Short-term disability • Education assistance • Financial education and support, including DailyPay • Wellness and Wellbeing programs • Caregiver support via Wellthy • Childcare referral service via Wellthy Apply tot his job