Pricing Analyst - Revenue Integrity

Your job is more than a job

Under the general direction of the Senior Director of Revenue Integrity, the Pricing Analyst
is responsible for collecting, analyzing, and monitoring the organization’s pricing, cost, and budget data to positively impact financial performance and outcomes. The Analyst will need to utilize a variety of analytical methods, tools, models and techniques, as well as to translate government requirements to evaluate complex requests or situations.

Your Everyday

• Assist with annual rates and establishment processes for both hospital and professional charging /billing, for LCMC Health, including but not limited to:
  • Obtaining benchmarking data, volumes, reimbursement, and other information required to complete annual fee reviews to ensure pricing remains current and competitive
  • Compile data
  • Reporting as needed

• Assist with annual CPT code change process for both hospital and professional billing, for LCMC Health, including but not limited to:
  • Communication with various stakeholder groups such as Revenue Cycle Leaders, CDM Coordinators, Coding, Contracting, Reimbursement Managers, Revenue Cycle Directors, IT, etc.
  • Compile data
  • Reporting as needed
• Conduct detailed analysis of internal cost data, revenue, and payer contracts to evaluate pricing accuracy and financial impact.
• Monitor market trends, including competitor pricing and reimbursement patterns, to ensure the hospital's prices are aligned with industry standards.
• Identify opportunities for optimizing pricing structures to enhance revenue capture and improve profitability.
• Provide recommendations to leadership on potential adjustments to pricing models that could lead to increased revenue or reduced costs.
• Utilize knowledge of the healthcare industry, clinical and/or business workflows to propose data driven solutions and improvements while working collaboratively with various stakeholders
• Ensure that pricing strategies comply with federal, state, and local regulations, including those set by Medicare, Medicaid, and other third-party payers.
• Maintain current knowledge of regulatory requirements impacting hospital pricing, including transparency laws, billing regulations, and payer guidelines.
• Work closely with revenue cycle, billing, and finance departments to ensure pricing models align with reimbursement structures and maximize profitability.
• Coordinate with coding and charge capture teams to ensure that pricing reflects accurate service delivery and coding practices.
• Develop financial models to assess the impact of pricing changes on hospital revenue and overall financial performance.
• Utilize these models to project future pricing trends, helping leadership make informed decisions about adjustments or enhancements to pricing structures.
• Utilize SQL and other query tools to analyze large quantities of data, from multiple complex internal and external sources to glean understanding, derive actionable insights into organizational performance and the external environment, and measure progress toward strategic initiatives
• Prepare detailed reports and presentations on pricing strategies, market analysis, and financial impact to share with leadership and other stakeholders.
• Present findings and recommendations based on data analysis to executive teams for decision-making purposes.
• Participates in efforts to review and analyze the chargemaster (CDM) to ensure consistency with industry standards and to ensure that change in pricing, CPT/HCPCS codes, and revenue codes are accurate and compliant with billing regulations
• Continuously monitor and evaluate the effectiveness of current pricing strategies and models, adjusting as necessary to respond to market conditions, regulatory changes, or financial goals.
• Develop, produce, validate, and distribute standard charge-related reports and ad-hoc reports as needed
• Works hand in hand with CDM Team for pricing of all chargemaster items

The Must-Haves

Minimum:

EXPERIENCE QUALIFICATIONS:

• High School Diploma and six (6) years of experience in accounting, finance or analytics that includes experience with computer systems, spreadsheet and database applications, data reporting and interpretation
• Bachelor’s degree and two (2) years of experience in accounting, finance or analytics that includes experience with computer systems, spreadsheet and database applications, data reporting and interpretation
• Preferred – Four (4) years of experience in accounting, finance or analytics that includes experience with computer systems, spreadsheet and database applications, data reporting and interpretation, as well as experience usi