Professional Non-Clinical
2019-R0207865 Requisition #
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Job Summary / Purpose

The Network Pricing Analyst provides analytical and pricing expertise for the evaluation, negotiation, implementation and maintenance of managed care contracts between CHI providers and managed care payers or networks. Coordinates and monitors contract performance for senior leadership. Supports strategies for maximizing reimbursement and market share. Aids the development of new managed care products with external payers consistent with CHI’s strategic plans. Work requires complex financial and contract analysis of healthcare reimbursement levels and methods

Job Responsibilities
  • Prepare routine reports and ad-hoc analyses as directed, with ability to accurately reflect actual performance trends
  • Act as a liaison between CHI and payer to update information and communicate changes
  • Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and prepare complex financial reimbursement analyses and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provisions, parameters and rate structures aimed at establishing reimbursement levels
  • Identify, collect, and manipulate data from a wide variety of financial and clinical internal data bases (e.g., Star, SQL, Payment Integrity Compass, EPIC, Meditech) and external sources (e.g., Medicare/Medicaid website). Identify risk/exposure associated with various reimbursement structures. Gather data and produce analytical statistical reports on new ventures, products, services, and strategies being considered. Perform sensitivity analyses such as modeling of modifications chargemasters.
  • Prepare and effectively present results to senior leadership, and other key stakeholder, for review and decision making activities
  • Maintain knowledge of hospital operations sufficient to identify causative factors, deviations, and variables that may affect report findings.  Ability to translate operational knowledge into data mining activities that identify unusual circumstances, trends, or activities.  Finally, the skill that combines the data mining activities and operational knowledge into hospital specific variance reports
  • Apply general contract knowledge to specific situations regarding reimbursement rates and payment terms to and provide feedback to leadership. 

Bachelor’s Degree in Business Administration, Finance, Healthcare or related field required or equivalent experience preferred.

Required Minimum Experience:
  • 0-5 years of business experience with 0-3 years of healthcare business management/reimbursement experience.
  • Healthcare, insurance or related industry experience preferred. Strong background in financial healthcare reimbursement analysis is required, including an understanding of diagnosis and procedure coding, billing practices, and payment methodologies. Managed care knowledge preferred.
  • Must be able to lead and coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines.
  • Applicant must possess strong interpersonal skills. They will need to site specific examples of interdepartmental collaboration successes and times where applicant used good judgement in sensitive business situations.
  • Applicant must have a desire for continued learning and professional growth. Managed care is a dynamic and changing environment that will require continued skill development and knowledge enhancement.
  • Travel is required for occasional outside meetings with physicians and senior executive from external payers.
  • Demonstrated   ability to show accountability for modules and systems to perform various calculations or operations.
Required Minimum Knowledge, Skills and Abilities
  • Required: Knowledge of insurance fee for service reimbursement.
  • Required: Advanced understanding of general office applications including Excel, Access, and SQL
  • Knowledge of general medical terms, procedural coding, and medical service billing.
  • Knowledge of database and interfaced based electronic environments.
  • Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community

About Us

Chances are, you’re here because you’re looking for a career offering greater opportunity, challenge and fulfillment. We’re confident you’ll find all three at CHI. As one of the nation’s largest nonprofit health systems, we offer a wealth of careers across more than 101 hospitals in 18 states. Our faith-based health system welcomes you to share in our mission of building healthier communities, whether as a surgeon in the operating room or an administrator in a conference room. When you work in a supportive environment with like-minded professionals, wonderful things happen. Learn More

Equal Opportunity Employment

Consistent with our Core Values, Catholic Health Initiatives employers are EEO/AA/M/F/Vets/Disabled Employers. Qualified applications will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identification, protected veteran status, disability or any other legally protected characteristic

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