Note: The job is a remote job and is open to candidates in USA. Tribunus Health partners with medical groups and healthcare organizations to improve financial performance and operational efficiency through payer contracting, reimbursement optimization, and client service. The Payer Contract Analyst performs scenario modeling, analyzes reimbursement data, supports managed care contract negotiations, monitors contract performance, and researches payer policies and regulatory impacts.
Responsibilities
- Contract & Scenario Modeling: Translate contract language into expected reimbursement and build flexible models that support scenario development. Our hospital work spans DRG case rates, tiered per diems, percent-of-charge, APC and EAPG outpatient methodologies, implant and high-cost drug carve-outs, and stoploss, outlier, and lesser-of-charges provisions; our professional work spans conversion-factor and fee schedule arrangements. Models aggregate fee-for-service and value-based data from multiple sources
- Training and Support: Serve as an expert resource and trainer for colleagues on hospital and professional reimbursement methodologies and fee schedule analysis
- Data Vendor Lead: Lead relationships with applicable data vendors (price transparency, claim utilization, etc.) and disseminate information about updates and functionality improvements
- Strategic Data Utilization: Analyze contracts and historical reimbursements to inform strategy and shape contract proposals
- Performance Monitoring: When included in a client engagement, validate payer rate loads to ensure contracts are being executed accurately and perform root-cause analysis of variances
- Market & Policy Research: Monitor payer policy updates and quantify the impact of potential material harm and other contract implications
- Cross-Functional Support: Serve as a resource to company leadership to assist in ad-hoc projects and update internal tracking systems as analytical work is completed
Skills
- The ideal candidate will have, throughout their career, demonstrated the ability to answer pertinent business questions using all available data assets and achieve targeted outcomes both individually and in team settings
- Experience performing contract analytics in a hospital setting is required
- Location is flexible, with many individuals remote and hubs in Charlottesville, VA, Washington D.C., and Philadelphia, PA
- Bachelor's Degree Finance, Healthcare Administration, Business or related field
- 5+ years in payer-related roles within the provider or insurance industry, including at least 3 years in net revenue reimbursement modeling, financial analysis, and performance computation
- Hospital contract modeling experience is required
- You should be equally comfortable building expected-reimbursement logic from a contract and working inside a model you didn't write — including one a client or a payer built to support their own number
- Professional fee schedule modeling experience is also required
- Proficiency in contracting analytics, with the ability to harness reimbursement data to inform decisions and quickly assess a provider's value relative to its competitors
- Intermediate to advanced capabilities with Microsoft Excel and PowerPoint, along with experience building and manipulating Contract Modeling tools and extracting data from online databases (price transparency, etc.)
- Strong project management skills, excellent attention to detail, and efficient conceptualization and logic skills
- Excellent written and verbal communication skills, including strong internal customer service orientation
Benefits
- Eligible for additional annual performance bonus based on organizational scaling metrics.
- For full-time individuals, additional benefits include a comprehensive medical benefits package and employer contribution to a 401k plan.
- We are open to part-time and hourly arrangements.
Company Overview