Payor Network Payor Provider Analyst

Primary City/State:

HonorHealth - 8125 N Hayden Rd Scottsdale, AZ 85258

Category:

Contract Management

Shift:

Day

Department:

Payor Contracting

Remote in the state of Arizona

Must reside in the state of Arizona

Great care starts with great people. (Like you.)

At HonorHealth, you’ll find something special. From humble beginnings in 1927 to one of Arizona’s largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.

Responsibilities:

JOB SUMMARY

Develops, analyzes and provides quality and timely decision-making information to Executives to increase profitability, decrease costs and drive system change, through analysis of payor and provider contracts for services, which include all facilities, physicians and affiliates ("Network"), with annual revenues of $900M. Models payor contracts, develops proactive analysis and reporting methodologies related to Network profitability, organizational revenue, and utilization trends that drive costs, revenue and financially related compliance risk. Provides leadership and works closely with external and internal stakeholders to generate reports from computer software systems to use for analysis and comparison in evaluating data.

ESSENTIAL FUNCTIONS

• Develop analytical strategies and methodologies to support revenue generation through the blend of contracting and revenue cycle processes, i.e. capture coding in contracts to realize revenue. Works closely with Financial Analytics, Finance, Revenue Cycle, Care Management, Medical Directors, Compliance and Quality, to obtain high integrity data to support analysis. Data includes but is not limited to financial, utilization, market and demographic data pertaining to health plans, intermediaries, ambulatory surgical centers, health services, physician performance and network revenue and profitability
• Models Network payor contracts utilizing contract modeling system and other analytical strategies and methodologies to analyze and trend network and facility specific revenue, profitability and utilization data.
• Generates formats and reports through system software to interpret and present health plan contracting and utilization data, independent physicians to key senior management teams and physician leaders. Maintains accurate concise documentation of data input sources and analytical methodologies.
• Works closely with the Associate Vice President Payor Contracts and collaboratively with the Payor Contracting team in payor negotiations, problem solving and reporting. Works closely with the Associate Vice President Provider Contracts and the Provider Contracting team to develop standardized analyses and reporting for independent physician fair market value analyses and contracting.

EDUCATION

• Bachelors or 4 years' work related experience Required

EXPERIENCE

• 3 years data mining and analysis related to healthcare and health plans Required
• 5 years experience Preferred

LICENSE AND CERTIFICATIONS

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