Payer Contracting Analyst – Value Based Care (Days, Local Remote)

at  The University of Chicago Medicine

Job Description:
Be a part of a world-class academic healthcare system at UChicago Medicine as a Contracting Risk Analyst – Value Based Care for the Finance Managed Care department.This position is a hybrid remote opportunity with occasional requirements to come in off at our Burr Ridge or Hyde Park locations.
The Contract Risk Analyst – Value Based Care is responsible for analyzing and modeling Value Based Care (VBC) and population health risk agreements on behalf of the Office of Managed Care (OMC) and the UChicago Medicine Clinically Integrated Network (CIN), including but not limited to Medicare Advantage, Medicare CMMI Accountable Care Organizations (ACOs) for shared savings (MSSP and ACO Reach), Commercial ACOs, Bundled Payments, Capitation, Direct to Employer (DTE), and global risk agreements. Partners with the Contracting team (FFS and VBC), CIN and the clinical teams on evaluating VBC risk contracts, incentive programs and distribution, incentive funds flow, calculating and modeling projected financial risk performance (such as risk corridor scenarios, stoploss/reinsurance, feasibility, and scenario analyses). Analyst works with senior leadership to support future financial goals and strategies related to its entities, as well as modeling and forecasting. The analyst assists VP of Payer Strategy, OMC Directors and CIN leadership during risk-based contract negotiations to ensure successful contract negotiation and implementation, monitoring and enforcement of contract terms and support for value base care contracting initiatives and serves as a subject matter expert for risk based contract terms developing monitoring tools and reporting to proactively manage and mitigate risk and improve contract performance. Analyst monitors and reviews existing and new CMMI Government Programs (MSSP, etc) understanding the risk components and partnering with the Director, Value Based Payment Models and BI Analyst to assess feasibility and requirements for participation. . Collaborates with interdisciplinary teams across the care continuum – Decision Support, Financial Planning, Budgetary, etc to support enterprise wide alignment and reporting around VBC programs. Actively embodies Mission, Vision, and Value of UCM.

REQUIRED QUALIFICATIONS:

• A Bachelor’s degree in Business, Finance, Healthcare, or related field, or a combination of relevant education and experience. Advanced Degree in Finance based disciplines are preferred.
• Five or more years of experience in a multi-facility health system in either: Prior experience with value-based care (VBC)/alternative payment models
• Five or more years’ experience in multi-facility health system, large academic and community physician groups or clinically integrated network, large academic medical center or insurer environment.
• Experience in the following areas highly desirable:
• Risk programs analysis and reporting – including Medicare Advantage, Bundled Payments, and ACOs.
• Experience in supporting risk based contract negotiations.
• Experience with Health system data warehouses and datamarts.
• Knowledge and experience in VBC provider incentive distribution managementprograms and incentive funds flow preferred.
• Payer experience preferred
• Requires detailed knowledge of hospital and physician complex value based care (VBC) risk reimbursement methodologies including shared savings, capitation, downside risk, % of premium, global risk and bundled payments.
• Experience with CMS CMMI governmental programs related to Medicare and Medicaid highly desirable.
• Requires detailed knowledge of hospital and physician complex VBC methodologies, particularly Value based care (VBC) risk reimbursement structure knowledge.
• Excellent understanding of risk based contracts, including:
• Proficient understanding of MSSP and Medicare Advantage contracting methodologies, upside/downside risk corridors, Stop-Loss provisions, financial effect of risk capture, among others.
• Proficient understanding of payer claims files and file formats, including Revenue Code and CPT coding in a clinical/hospital/ASC/physician office setting.
• Proficient manage care contract rate interpretation skills
• Demonstrated advanced technical skill and knowledge of healthcare EDW data systems and query languages.
• Experience in population health and value based care data repositories, third party software tools, and working with payer claims datasets.
• Experience with payer compliance review including underpayment variances and denial management highly desirable.
• Requires familiarity and aptitude with risk contracts and associated payer and provider datasets, and modeling systems and/or cost accounting systems that build payer risk contract profiles.
• Ability to analyze and integrate complex internal and external datasets.
• SQL skills preferred.
• Requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case for a recommended course of action.
• Excellent analytical and problem solving skills, and the ability to make decisions quickly and independently.
• Strong attention to detail and well organized.
• Adapts well to rapid change and multiple, demanding priorities with excellent time and project management skills.
• Ability to understand and interpret federal regulations and policies, coding guidelines and reimbursement changes.
• Interact effectively with colleagues in a variety of contexts and forums and contribute as a team player.
• Demonstrated ability to self-direct, multi-task and partner with technical staff from different departments.
• Ability to work remotely as business needs require while remaining an engaged member of a team.
• Microsoft Office Suite advanced proficiency also required, particularly Excel. Strong aptitude for learning additional software or systems as needed, particularly finance and revenue cycle billing systems.

Please refer the Job description for details