Payer Analytics Consultant – Defined Term

🕒 il y a 14 jours

🏄 California – Distant

🏄 California – Remote

💵 $125 000 - $140 000 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

💼 Consultant

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Central California Alliance for Health

Site WebLinkedInTous les Emplois

501 - 1000 employés

Fondée en 1996

⚕️ Assurance santé

🤝 À but non lucratif

Healthcare Insurance • Non-profit

Alliance pour la Santé de Californie Centrale est une organisation régionale de santé à but non lucratif qui fournit des services de gestion des soins Medi-Cal aux résidents de plusieurs comtés de Californie centrale, y compris Mariposa, Merced, Monterey, San Benito et Santa Cruz. L'organisation offre une large gamme de services de santé, y compris les soins primaires, la santé comportementale, le soutien pharmaceutique et la gestion des maladies, en se concentrant sur l'amélioration de la coordination des soins et l'accès aux services de santé pour ses membres. Alliance pour la Santé de Californie Centrale s'engage également avec les communautés à travers des subventions et des partenariats afin d'améliorer l'accessibilité et la qualité des soins de santé. L'organisation soutient ses membres avec des services tels que les soins dentaires et de la vue, la planification familiale, le transport et l'assistance linguistique. De plus, elle fournit des ressources pour l'éducation à la santé, des services de télésanté et la gestion de cas complexes.

Description

• Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies • Conducts moderately complex financial analysis to support successful payer reimbursement outcomes • Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives

🎯 Exigences

• Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field • A minimum of three years of experience performing financial healthcare reimbursement analysis (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying • Knowledge of: • Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems • Methods and techniques of financial modeling and analysis • Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers • Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types • National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models • Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau • Ability to: • Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations • Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action • Translate data into understandable information and deliver solutions that improve business processes • Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs • Interpret and apply rules, regulations, policies, procedures, and guides • Work collaboratively with individuals at all levels of the organization while supporting multiple stakeholders

🏖️ Avantages

• Medical, Dental and Vision Plans • Ample Paid Time Off • 12 Paid Holidays per year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Robust Health and Wellness Program • Onsite EV Charging Stations