Sr. Health Economics Strategist

Summary:

The Sr. Health Economics Analyst, Contracting and Network Strategy will be responsible for the development and presentation of analytics related to support of the Contracting department’s strategies, including benchmarking of market cost and utilization trends and patterns. Will have strong leadership ability to create analytical models and lead technical design with data integrity and efficiency as guiding principles. Provides decision support to the Contracting and Finance leadership. Leads development of provider reimbursement analysis and models (involving multiple variables and assumptions) to support a variety of reimbursement strategies, approaches, and provisions.

The Sr. Health Economics Analyst, Contracting and Network Strategy serves as a primary contact and content creator for provider network financial data, for purposes including but not limited to existing provider contractual relationships, proposed provider or vendor contracts, renegotiation of physician, hospital, or ancillary provider contracts, and ad hoc reporting and analytic models to support Provider Network strategy and operations.  This role requires a combination of technical skills in data analysis, a broad understanding of health plan functions and provider claims, and the business acumen to understand financial concepts. This role is required to translate contract provisions into financial models, identify opportunities and challenges associated with HNE’s Total Medical Expense, and perform other analyses as required by the VP of Provider Network Strategy & Management or their designee.  The Sr. Provider Network Analyst is a senior-level individual contributor role and reports to the VP, Provider Network Management.

Essential Functions:

Financial Analysis and Report Development

• Performs ongoing market analysis using benchmarking across HNE network providers using a standard CMS approach with various types of reimbursement methodologies (DRG, RVUs, ASC, OPPS, AWP & ASP etc.)

• Leverages relationships and collaboration across multiple HNE departments to build a high level of trust and collaboration in report development, analysis, and timely delivery

• Interprets financial, accounting, and contractual information to ensure accuracy of data used in reporting, analysis, contract modeling, and forecasting

• Utilizes software including Amisys, Microsoft (Access, Excel, SQL Server) and/or SAS to perform queries utilizing the data warehouse, to refresh financial models by line of business, individual provider negotiation models, and/or other ad hoc reporting

• Resource for other members of the department/division on data-based business processes and may be responsible for training and guidance of other associates

• Presents data driven financial information and succinctly communicates analytic results to internal and external stakeholders

• Evaluates and researches departmental data needs by engaging stakeholders and identifying inefficiencies/waste, risks, and key person dependencies

• Identifies areas of opportunity to further enhance financial processes and data mining to better align with the corporate-wide strategy of Caring, Simplification, and Affordability

• Identifies major cost drivers and recommends strategies for mitigating the cost drivers

• Continuous education in federal, state, and industry reimbursement and analytic models

 Additional Analysis and Support Duties

• Works in partnership with multiple business areas to create comprehensive documentation (SOPs), training, and identify key dependencies and needs for Provider Network planning, strategy, and operations.

• Generates reports used to analyze network adequacy, perform gap analysis, and support design & construction of optimally-sized networks meeting all state and federal regulatory requirements

• Communicates to stakeholders and leadership on project status, outcomes, and improvements

• Provides ad-hoc reporting and analysis for financial, governmental, pharmacy, and administrative data used in strategic decision-making

• Understanding and competency with Quest Analytics for network adequacy and accessibility analysis reporting

• Familiarity with the Massachusetts All Claims Payer Database and ability to retrieve strategic data from this database and other external reference sources

• Performs sensitivity analysis to identify risk/exposure associated with payment changes

Minimum Requirements:

Education and Experience:

• Three to five (3 to 5) years of design, modeling and analysis of healthcare claims data

• Minimum of four (4) years of health care expe