Provider Reimbursement Consultant - Health - 9828
Client looking for an analytical candidate with strong claims data experience and someone who really likes diving deep into the data. Position can be hybrid or fully remote. Also open to someone on an actuarial track or non actuarial who still enjoys the data and analytical type work. This position will work collaboratively with the provider network strategy department to develop tools and reporting infrastructure to monitor provider network performance, support organizational decision-making, and identify opportunities to improve quality and control costs. Looking for someone to help in analytics for provider contracting.
Provide ad hoc analytics to support provider contracting discussions and strategic partnerships
Develop tools and reporting infrastructure to monitor provider network performance by using Excel, SQL, Access, or other data analysis tools
Develop analyses and reports to support decision making related to provider contracting
Develop ad hoc analyses of varying levels of complexity to support provider contract negotiations and strategic partnership discussions.
Conduct independent research and analysis using regulatory guidance, government data and statistics, reports, publications, and other publicly available data sources to inform network development activities and decision-making
Support collaboration between contracting and other internal stakeholders related to the identification and implementation of quality-improvement and cost-savings initiatives
2+ years of experience with provider contracting, health care reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare)
Experience with health care claims data and risk adjustment methodologies (e.g., DRG, RVU, CMS HCC, etc.), actuarial models and forecasting
Experience using common data analytics tools, including Excel, Python, R, SAS, SQL, or other analytical tools
Experience using Looker, Tableau, or other visualization software a plus.
Strong analytical skills and familiarity with common data analytics tools, including Excel, Python, R, SAS, SQL, or other analytical tools
SAS, VBA, Milliman MedInsight/Repricer