Job Description

Employment Status:
Full time
Job Function:
Professional
Department:
417501 Payor Relations-Mgmt
Shift Hours / Days:
Hours / Pay Period:

SR ADVISOR, BUSINESS ANALYTICS

Sr. Adviser, Business Analytics is responsible for the analytical support for pricing strategy and modeling of CTCA payer and employer contracts, supporting wholesale and retail pricing decisions, and providing technical insight into new initiatives in value based payment.

This position will support the evaluation and implementation of pricing strategies and tactics for markets, facilities, services and payers across the CTCA system.  Collaboration with other teams across the system is extremely important.  Projects and responsibilities include: 

  • Develops and implements pricing analytics across entire CTCA payer portfolio of multiple and diverse services and markets, including:
    • Fee-for-service arrangements for facility, physician and ancillary agreements with third party payers, both wholesale and retail
    • A strategic framework for CTCA charge masters and rate structures
    • Strategic tools, analyses and models to monitor and evaluate the impact of pricing strategies, decisions and negotiations
    • Key contributor to the development of the Access Department revenue forecast.
    • Develops an analytic narrative that includes executive summaries, significant findings and conclusions for use the CTCA leadership.
  • Supports the contract negotiation process through proposal evaluation and development. This position also provides into the financial and volume effects of payer and CTCA offers.
  • Supports the valuation assessment of a payer relationship, including modeling contractual variables, and assessment of contractual language and reimbursement terms.
  • Establish rate schedules, key financial terms, contract exhibits and technical documentation to support the contract negotiation process.
  • Plays key role in developing and maintaining contract profiles containing comparative information on each contract’s financial terms, key provisions and performance
  • Creates tools, reports, and models to evaluate and monitor payer revenue and contract performance for the payer portfolio, including profitability reporting..
  • Establish and maintain market and pricing intelligence capabilities to inform and influence pricing strategy decisions, including:
    • Patient focused pricing oriented market research (e.g. establishing demand curves and price elasticity’s via methodologies such as conjoint analysis)
    • Competitive price intelligence for existing and potential services (e.g. purchased data, mystery shopping, web sites, etc.)
  • Evaluate and monitor developments in value based payment and recommend competitive and viable financial structures for new and existing contracts.

Qualifications:

  • Bachelor's Degree
  • Displays a high level of critical thinking to address complex business problems
  • Thorough knowledge of provider pricing, healthcare finance, payment models and payment structures.  This position will have insight into developing the appropriate structure to support CTCA contracting objectives.
  • Considerable knowledge of alternative reimbursement methodologies across provider types and product line, as applied to oncology
  • Understanding of healthcare expense risk and opportunity fee for service, its components (unit price and frequency), and drivers. 
  • Considerable knowledge of billing and collection process across provider types. 
  • Considerable personal computer skills including but not limited to spreadsheet and database programs. 
  • Ability to manage multiple projects and meet deadlines along with flexibility in changing priorities.
  • Presentation and communication skills required.  Analytical and problem solving required. 
  • Knowledge of managed care contracts and hospital managed care finance, claims payment, methodologies, procedures, controls and CPT, HCPCS, ICD-9, DRG coding preferred
  • Familiarity with decision support systems, contract negotiation and/or analysis, reimbursement modeling, patient accounting and patient access systems
  • Strong problem solving and analytical skills; ability to utilize and interpret financial models and internal analyses
  • Effective negotiation and communication skills, and ability to collaborate with varying individuals throughout the system as well as with external contacts
  • Ability to develop and maintain professional relationships, maintain confidentiality, and to manage multiple tasks simultaneously

#LI - KE1