Senior Analyst Payor Contracting

Job Code: 29017

Position Summary

Supports payor contracting by providing analyses related to the negotiation, pricing, implementation, ongoing maintenance, and performance of Kootenai Health contracts. Responsible for a variety of projects, including research and analysis of issues related to hospital and physician fee-for-service reimbursement, alternative payment arrangements, price transparency, fee schedule development and monitoring of key performance indicators. Presents findings and recommendations to leadership.

Responsibilities

• Partners with various hospital, clinic, and revenue departments to identify areas of potential revenue optimization and assess operational and financial implications; presents findings to leadership using a data driven approach to make recommendations

• Develops financial models to project reimbursement rates, financial impacts, and potential risks associated with contract terms

• Prepares and distributes analyses to understand the financial impact of new and existing payor contracts and collaborate with leadership to support payor negotiations

• Provides comprehensive reporting to detail contract performance, benchmarking contracts to ensure rates and terms are favorable and in line with industry standards and company expectations

• Creates and maintains dashboards and scorecards to track payor performance

• Works with application and business analysts to test and validate reports

• Leads specific department and inter-departmental projects such as underpayment recovery, billing support, and payor specific denial reduction projects

• Maintains knowledge of commercial and government reimbursement models and regulations, concepts, practices and procedures and their impact on payments

• Effectively uses a variety of tools to initiate projects, monitor progress, anticipate obstacles, and provide concise updates in a timely manner

• Proactively identifies issues, addresses concerns, and makes recommendations

• Familiar with standard concepts, practices, and procedures within the field

• Relies on experience and judgment to plan and accomplish goals

• Regular and predictable attendance is an essential job function

• Competent to meet age specific needs of the unit assigned

• Performs other related duties as assigned

Requirements and Minimum Qualifications

• Bachelor’s degree in finance, accounting, data science, or healthcare related field required; Master’s degree preferred

• Minimum 3 years’ relevant experience required

• Previous experience in payor contract negotiation, coding, billing, and Accounts Receivable basics required

• Advanced technical skills, including manipulation of large data sets, database management, experience with querying language and financial modeling

• Strong communication skills with the ability to turn data into actionable information

• Strong quantitative skills with the ability to understand complex concepts

• Excellent organizational and project management skills; able to manage multiple concurrent projects and deadlines

• Familiarity with current common coding practices including CPT4, ICD9CM, and DRGs as well as current Medicare reimbursement methodologies and quality initiatives

• Knowledge of pricing, healthcare finance, managed care, provider incentives, and risk contracting required

Working Conditions

• Must be able to lift or move up to 10lbs

• Must be able to maintain a sitting position

• Typical equipment used in an office job

• Repetitive movements

• Remote eligible

About Kootenai Health

Kootenai Health is a highly esteemed health care organization, serving patients throughout northern Idaho and the Inland Northwest. We pride ourselves on our outstanding reputation as both an employer and a health care provider. We have been recognized with many accolades and distinctions including being recognized as a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet™ Status for Nursing Excellence.

As your next employer, we are excited to offer you:

• 100% employer-paid health insurance premiums for full-time employees. Part-time employees pay only a small portion a month for medical, dental, and vision coverage. Benefits start 1st of the month following 30 days of employment


• A tuition assistance program available after 90 days. If you want to further your education, we'll help you pay for it


• Kootenai Health will match your contributions in a defined contribution 457 retirement plan based on years of service ranging from 3-6 percent. Kootenai Health will contribute an amount equal to two percent of your gross earnings


• Competitive salaries with night, weekend and PRN shift differentials


• An award-winning and incentive-driven wellness program. Including a MyHealth corporate team, onsite financial seminars and coaching


• Employees receive discounts at The Wellness Bar, PEAK Fitness, various cell phone carriers, and more


• Robust and interactive employee bonus program, utilize our mobile ERIN app to alert employees to new positions, make referrals and track your bonuses


• And much more

If you strive to be an integral part of a high-quality healthcare system like Kootenai Health, we want to meet you!

Apply today! Please reach out to Recruiter or Front Desk with any questions.

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.