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The primary focus of this position is to utilize healthcare claim data to support Payer Relations and Contracting staff with analysis of charges and payments. The position will analyze data from various sources and systems for both physician and hospital services in order to present reports to key management and staff and to recommend and implement solutions to assist in the contract negotiation and decision making process.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor's degree in finance, accounting, economics, general business management, information technology/computer science, engineering, or health care management.
2. Two (2) years of experience in data or financial analytics.
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. Master's Degree in finance, business management, accounting economics, or public/health administration.
2. Comprehensive understanding of physician groups and hospitals.
3. Experience in health care management, related contracting field, health care insurance services/industry, hospital finance and/or healthcare consulting.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. In coordination with department staff, extracts data from various internal and external sources and conducts analysis of revenue for all third party payer contracts and monitor existing effective payment percentages, in addition to modeling.
2. Identifies data uses and develop analysis opportunities that are currently not used.
3. Performs data analysis and creates queries, programs and automation related changes in payer contracts or other programs affecting payment.
4. Manages Price Transparency machine readable files to comply with CMS regulation.
5. Develop and maintain rate monitoring tools for different service lines across WVUHS.
6. Provide support and create complex presentations, database and spreadsheets utilizing skills with various programs such as Excel, Access and PowerPoint on the PC.
7. Leads data requirements gathering for problem identification, resolution, and solution design.
8. Provides analytical insights from data to drive strategic business decisions.
9. Acts as a liaison to key internal departments regarding professional and hospital contract rate updates.
10. Analyze data from various sources and systems in order to present reports to key management and staff and to recommend and implement solutions to assist in the contracting decision-making process.
11. Manages workload and balances quality of work with deadlines to fulfill user expectations and project goals.
12. Develop and maintains databases to track incentive-based reimbursement. Ensures data integrity and accuracy.
13. Communicates to all parties the natures, significance and risk factors of corresponding projects.
14. Participates in post implementation review of projects.
15. Gathers customer requirements to understand business needs and translate into actionable solutions.
16. Team Building- Participates in training and professional development sessions.
17. Offers assistance and support to co-workers.
18. Contributes to building positive team spirit and cohesiveness.
19. Balances team and individual responsibilities.
20. Works proactively and cooperatively in group problem-solving situations.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to sit for long periods of time.
2. Ability to lift, push or pull 5-10 pounds.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment.
SKILLS AND ABILITIES:
1. Ability to handle and maintain confidential information.
2. Ability to work well under high stress conditions.
3. Ability to work independently or cooperatively as a team member.
4. Ability to adapt to various workloads and assignments.
5. Ability to work with multi-disciplinary groups and facilitate meetings.
6. Basic understanding of terminology involved with healthcare insurance and healthcare analysis.
7. Solid knowledge and capable in computer use, including strong capabilities in ALL Microsoft Professional Office programs including Outlook, Word, Excel, Access, and PowerPoint.
8. Ability to prioritize tasks.
9. Must have independent decision-making ability.
10. Ability to work in a fast paced and rapidly changing environment.
11. Must be flexible.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Day (United States of America)
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
WVUH West Virginia University Hospitals
Cost Center:
649 SYSTEM Managed Care and Payer Relations
Address:
1085 Van Voorhis Rd
Morgantown
West Virginia
The primary focus of this position is to utilize healthcare claim data to support Payer Relations and Contracting staff with analysis of charges and payments. The position will analyze data from various sources and systems for both physician and hospital services in order to present reports to key management and staff and to recommend and implement solutions to assist in the contract negotiation and decision making process.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor's degree in finance, accounting, economics, general business management, information technology/computer science, engineering, or health care management.
2. Two (2) years of experience in data or financial analytics.
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. Master's Degree in finance, business management, accounting economics, or public/health administration.
2. Comprehensive understanding of physician groups and hospitals.
3. Experience in health care management, related contracting field, health care insurance services/industry, hospital finance and/or healthcare consulting.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. In coordination with department staff, extracts data from various internal and external sources and conducts analysis of revenue for all third party payer contracts and monitor existing effective payment percentages, in addition to modeling.
2. Identifies data uses and develop analysis opportunities that are currently not used.
3. Performs data analysis and creates queries, programs and automation related changes in payer contracts or other programs affecting payment.
4. Manages Price Transparency machine readable files to comply with CMS regulation.
5. Develop and maintain rate monitoring tools for different service lines across WVUHS.
6. Provide support and create complex presentations, database and spreadsheets utilizing skills with various programs such as Excel, Access and PowerPoint on the PC.
7. Leads data requirements gathering for problem identification, resolution, and solution design.
8. Provides analytical insights from data to drive strategic business decisions.
9. Acts as a liaison to key internal departments regarding professional and hospital contract rate updates.
10. Analyze data from various sources and systems in order to present reports to key management and staff and to recommend and implement solutions to assist in the contracting decision-making process.
11. Manages workload and balances quality of work with deadlines to fulfill user expectations and project goals.
12. Develop and maintains databases to track incentive-based reimbursement. Ensures data integrity and accuracy.
13. Communicates to all parties the natures, significance and risk factors of corresponding projects.
14. Participates in post implementation review of projects.
15. Gathers customer requirements to understand business needs and translate into actionable solutions.
16. Team Building- Participates in training and professional development sessions.
17. Offers assistance and support to co-workers.
18. Contributes to building positive team spirit and cohesiveness.
19. Balances team and individual responsibilities.
20. Works proactively and cooperatively in group problem-solving situations.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to sit for long periods of time.
2. Ability to lift, push or pull 5-10 pounds.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Standard office environment.
SKILLS AND ABILITIES:
1. Ability to handle and maintain confidential information.
2. Ability to work well under high stress conditions.
3. Ability to work independently or cooperatively as a team member.
4. Ability to adapt to various workloads and assignments.
5. Ability to work with multi-disciplinary groups and facilitate meetings.
6. Basic understanding of terminology involved with healthcare insurance and healthcare analysis.
7. Solid knowledge and capable in computer use, including strong capabilities in ALL Microsoft Professional Office programs including Outlook, Word, Excel, Access, and PowerPoint.
8. Ability to prioritize tasks.
9. Must have independent decision-making ability.
10. Ability to work in a fast paced and rapidly changing environment.
11. Must be flexible.
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Day (United States of America)
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
WVUH West Virginia University Hospitals
Cost Center:
649 SYSTEM Managed Care and Payer Relations
Address:
1085 Van Voorhis Rd
Morgantown
West Virginia
