Sr. Contract Financial Analyst
Company Name:
Centene
## Description
Position Purpose: Serve as the subject matter expert to on issues related to provider reimbursement
Evaluate the effectiveness of contracting strategies, payment methodologies and rates in comparison to budget of quality initiatives
Establish financial benchmarks for provider reimbursement and analyze the impact of contracts submitted by the Health Plans
Manage and modify the process for changes to outcomes analysis reports due to various needs and concerns
Prepare and present information on emerging and industry standard reimbursement methods, competitive information, and national initiatives to management in support of network strategy discussions
Oversee various projects including the design of physician incentives and other contractual arrangements
Maintains divisional provider reimbursement models providing analytic reporting capabilities for contracting staff, contract settlement, incentive pool distribution, and estimation of savings through a variety of proposed contract/reimbursement actions
Perform analyses of Health Plan reimbursements in comparison to Centene's national experiences
Develop, export and train Health Plan financial analysts on the use financial modeling tools for provider reimbursement and medical expense forecasting
Assist with formulating and administering organization policies and procedures
## Qualifications
Education/
Experience: Bachelor's degree in related field or equivalent experience. 6
years of provider reimbursement and analysis, application development, data/contract analysis and data mining or statistics, preferably in the healthcare industry. Working knowledge of contract management processes, claims processing procedures, reimbursement and payment methodologies, and claims systems requirements and controls. Experience with statistics and the application of higher level mathematical models to medical and pharmacy claims data.
## Job
Job: Network Development & Contracting
Primary Location: USA-Massachusetts-Waltham
Other Locations: USA-New Hampshire-Bedford
Organization: Granite State Health Plan
Schedule: Full-time
Req ID: 1003756Estimated Salary: $20 to $28 per hour based on qualifications.
Centene
## Description
Position Purpose: Serve as the subject matter expert to on issues related to provider reimbursement
Evaluate the effectiveness of contracting strategies, payment methodologies and rates in comparison to budget of quality initiatives
Establish financial benchmarks for provider reimbursement and analyze the impact of contracts submitted by the Health Plans
Manage and modify the process for changes to outcomes analysis reports due to various needs and concerns
Prepare and present information on emerging and industry standard reimbursement methods, competitive information, and national initiatives to management in support of network strategy discussions
Oversee various projects including the design of physician incentives and other contractual arrangements
Maintains divisional provider reimbursement models providing analytic reporting capabilities for contracting staff, contract settlement, incentive pool distribution, and estimation of savings through a variety of proposed contract/reimbursement actions
Perform analyses of Health Plan reimbursements in comparison to Centene's national experiences
Develop, export and train Health Plan financial analysts on the use financial modeling tools for provider reimbursement and medical expense forecasting
Assist with formulating and administering organization policies and procedures
## Qualifications
Education/
Experience: Bachelor's degree in related field or equivalent experience. 6
years of provider reimbursement and analysis, application development, data/contract analysis and data mining or statistics, preferably in the healthcare industry. Working knowledge of contract management processes, claims processing procedures, reimbursement and payment methodologies, and claims systems requirements and controls. Experience with statistics and the application of higher level mathematical models to medical and pharmacy claims data.
## Job
Job: Network Development & Contracting
Primary Location: USA-Massachusetts-Waltham
Other Locations: USA-New Hampshire-Bedford
Organization: Granite State Health Plan
Schedule: Full-time
Req ID: 1003756Estimated Salary: $20 to $28 per hour based on qualifications.
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