POSITION: Senior Financial Analyst – Revenue Modeling
LOCATION: Chicago, IL
SUMMARY
A large health system based in Illinois is looking for a Senior Financial Analyst – Revenue Modeling to provide financial and analytical support to contract negotiations with Managed Care Companies and providers (physicians). Assist in developing and maintaining contracts, related terms, and calculation models within various contract modeling systems for health system. Analyze contract data and resolve data discrepancies. Promote development of Population Health Management analytics, including CMS’ Bundled Payments for Care Improvement program (BPCI), Accountable Care Organizations and Entities (Medicare ACO and Medicaid ACE), the health system’s health plans, and global capitation models. Support analysis and development of provider reimbursement models to support physician contracting, and preparing provider distribution models. Publish results for executive management review. Support tool development to assist in performing analytics. Support contract performance reporting and preparing results for communication to management. Assist in system-wide efforts to capture, analyze and report data as it pertains to managed care.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Model contract proposals using revenue modeling components of various modeling software to maximize reimbursement for the health system, including modeling contracts for acute care facilities, ambulatory/professional services, behavioral health, home health and skilled nursing facilities. (Refer to specific systems in Section 5).
2. Modeling to include, but not limited to, volume, charges, expected and actual payment, contribution margin, contribution margin percent, profit and profit percent. Modeling to compare consolidated inpatient and outpatient services, bundled services (payments), and financial performance by inpatient and outpatient service lines.
3. Physician/provider modeling to support managed care negotiations with providers.
4. Perform physician distribution analytics and prepare executive management reporting to communicate results and obtain the health systems executive committee approval.
5. Defining and preparing Population Health Management analytics for BPCI, Accountable Care Organizations and Entities (Medicare ACO and Medicaid ACE), the health systems health plans, and global capitation models that will support contract negotiations.
6. Perform reimbursement modeling needed to establish an adequate provider network.
7. Responsible for changing existing contract rates or loading new contract rates into the contract modeling software in order for contract modeling to remain current.
8. Utilizes thorough knowledge of various contracting structures and payment methods including per diems, case rates, percent of billed charges, MS-DRGs, APR-DRGs, package pricing, ambulatory surgery groupers, Medicare outpatient rates, Medicaid / insurance exchange, carve-outs, stop losses, etc., to assure maximum positive net reimbursement for the health systems services.
9. On an ongoing basis but not less than quarterly, monitors the financial and operational performance of each contract relative to established current and future contracting goals. Continuously evaluates the feasibility of improving payment rates, rate structures, and maximizing reimbursement for managed care contracts.
10. Monitors new contracts in software programs to assure modeling outcomes are accurate. Provides analytical support using HPM and e-Simon, in addition to other systems. Downloads patient level and product department level detail from the cost accounting systems and, based upon the data, develops profitability statements.
11. Provides project specific analytics focused on one time data evaluations or comparisons of rate issues.
12. Analyzes ongoing contracts and payments to ensure actual rates and payments received are in adherence with existing contracts terms.
13. Lead analytical staff support for SNFs, Home Health Care, Behavioral Health, Worker’s Compensation, Intermediate Care Centers, outpatient imaging services, etc.
14. Participates in the planning, development, review and modeling of current and proposed payor rate proposals in conjunction with the lead senior analyst. Continuously evaluates rate offers and develops counter offers in order to achieve the desired financial results.
15. Reviews and modifies adjustments to existing pricing models, shared savings and incentive programs, to increase accuracy of financial projections.
16. As appropriate, shares modeling results with payors as part of the negotiations process. Analyzes payor modeling and make recommendations regarding the accuracy of the modeling. Works cooperatively to resolve modeling differences.
17. Communicates contract issues to the appropriate System Director or System Manager and the PFS / Under payment Unit.
18. Works with finance staff to develop projections for annual budget process, as well as analyze new contract proposals in comparison to the budget at a contract payor level. Periodically monitor actual reimbursement / contract performance against budget projections.
This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. Other duties may be assigned.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Background must include an understanding of medical terminology and health care concepts, including knowledge of ICD-9, CPT-4, and DRG coding concepts. Knowledge of ICD-10 is a plus.
2. Knowledge of managed care payment methodologies, and a working knowledge of reimbursement methodologies such as RBRVS and other standard fee schedule pricing is also preferred.
3. The ability to analyze complex problems, draw relevant conclusions and implement comprehensive solutions.
4. Excellent analytical and problem solving skills; excellent verbal and written communication skills.
5. Knowledge of McKesson Contract Modeling (PMOD), HPM, Optum, e-Simon, Accretive Health SURE Decisions, Payment Integrity Compass (an Advisory Board product) and/or other comparable software is preferred but not required.
6. Assist in developing tools and analytics around Population Health Management to include but not be limited to: Shared Savings Programs, Bundled Payments, Performance/quality bonuses, global capitation, and Narrow network modeling.
7. Understanding of Medicare and Medicaid is preferred.
8. Experience in physician reimbursement modeling and contract negotiations is a plus.
Education and/or Experience
1. Bachelor’s Degree in mathematics, statistics business, finance, or health care administration, or other discipline, with three years of relevant work experience.
2. Three (minimum) to five years of applicable experience including analysis, forecasting, modeling, etc. One to two years of experience in a healthcare environment preferred.
Computer Skills
1. Strong computer skills required (proficiency in Excel and PowerPoint a must, SQL preferred). Working knowledge of financial systems and financial and contract modeling software (Payment Integrity Compass (PIC) is preferred.
Form Rev 2/8/11