Value Based Payor Contracting Program Analyst

General Summary

Responsible for coordinating the relationship, managing and obtaining the expected reimbursement, budgeting, analyzing payor data, understanding the intent of the contract and payor contracting operational aspects of the contractual and voluntary value-based/pay for performance programs with Contracted Commercial, Medicare Advantage and Medicaid MCO Payors and appropriate WellSpan Health's internal teams. Provides financial support and works collaboratively with management & other members of the value-based program teams for financial analysis, planning budgeting and performance improvement of the value-based programs. To accomplish strategic goals, this position provides value-based program financial information for a variety of high-profile financial projects.

Duties and Responsibilities

Essential Functions:

• Acts as the liaison between the Payor and WellSpan Health to facilitate communication amongst the parties and resolve adversity for value-based programs.
• Facilitates internal and external payor meetings, assures contractual compliance, follows up with clinical partners to assure compliance with the programs.
• Tracks, monitors, analyzes, improves upon, and assures the revenue integrity of value-based programs for WellSpan, including but is not limited to, medical programs, behavioral health programs and ancillary programs.
• Provides and improves upon financial analysis of opportunity revenue, expected or budgeted revenue & actual revenue of each program, for WellSpan Health as a whole and/or segregated by entity and program. This includes but is not limited to the DHS and CMS routine (non-MSSP type) value-based programs.
• Facilitates and/or prepares annual budgets in coordination and liaison with operating managers.
• Models potential value-based programs for new or changed programs.
• Possesses expertise on each value-based programs and assures that internal WellSpan understand the program and how it impacts their respective areas.
• Maintains knowledge of industry accepted value-based programs, risk contracting/operational challenges and other value-based initiatives including but not limited to State and Federal MCO regulatory programs
• Collaborates with Quality Directors, Senior Management, and other value-base team members to provide financial information for their presentation to ancillary, medical group, hospital/corporate leadership and quality councils on the status, specific successes, & opportunities of improvement of programs. Collaborates with operations leadership in developing and monitoring relevant financial performance metrics and financial data analysis to determine profitability and identify areas for improvement. Works collaboratively with Directors of Payor Contracting to assure that WellSpan Health personnel is educated on the new or changed programs.
• Understands the utilization and/or the variance of healthcare services and quality measures and the effect on Shared Savings/Risk and Quality Incentives.
• Facilitates receipt of information from the payor and/or their portals. Assures that this information is efficiently accessible to the internal WellSpan staff. Maintains and manages the Teams portal for the payor meetings and internal WellSpan use. This shall include, but is not limited to, the education "manual" of each payor program.
• Participates in continuous assessment and improvement of value-based reporting, trending, and analysis from payor sources, as well as internal sources such as Milliman MedInsights, Epic Cubes and Slicer Dicer.

Common Expectations:

• Presents clear, concise, and simple presentation skills
• Enhances professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Attends meetings as required and participates on committees as requested.
• Performs other Payor Contracting or Value-Based Program related duties as identified.

Qualifications

Minimum Education:

• Associates Degree Required
• Bachelors Degree Preferred

Work Experience:

• 5 years Third Party Payor relationships/project management skills/evaluation and data analysis/healthcare financial analytical skills. Required
• Healthcare reimbursement/revenue cycle and third party payor value-based program management. Preferred and
• Supervisory/leadership experience. Preferred

Knowledge, Skills, and Abilities:

• Excellent written and oral communications and interpersonal skills.
• Computer skills.
• Able to work well within a team.

Benefits Offered:
Comprehensive health benefits
Flexible spending and health savings accounts
Retirement savings plan
Paid time off (PTO)
Short-term disability
Education assistance
Financial education and support, including DailyPay
Wellness and Wellbeing programs
Caregiver support via Wellthy
Childcare referral service via Wellthy