Provider Payment Analyst II

Overview Under the direction of the Provider Payment Strategy Manager, this position will support thedevelopment, evaluation, and advancement of provider reimbursement methodologies to alignwith organizational strategies and objectives, including performance and alternative paymentapproaches, and advise executive-level leadership regarding the feasibility of various strategies.This position will require the utilization of a variety of methods, models, and data sources toevaluate potential reimbursement methodologies and rates, will provide organizational educationrelated to Partnership’s network provider reimbursement, act as a subject matter expert, inform thedevelopment, maintenance, and implementation of business unit policies and procedures, andperform other duties as assigned. Responsibilities ▪ Supports the development, evaluation, and advancement of provider reimbursementmethodologies to align with organizational strategies and objectives, including performanceand alternative payment approaches, and advises executive leadership regarding thefeasibility of various strategies and methodologies, with duties including but not limited to:o Identifies strategies and tactics to advance provider payment methodologies, includingsupporting the Contracts team in language translation and development.o Creates, models, and implements reimbursement strategies, including alternativepayment and risk payment arrangements with hospitals, primary care and specialtyphysicians, skilled nursing facilities, and ancillary providers.o Develops materials to inform executives regarding the pros and cons of variousmethodologies, associated risks, and the feasibility of implementation.o Serves as a subject matter expert with comprehensive knowledge of provider networkand payment methodologies across all services.o Conducts complex research and analysis of various internal and external data sources toinform provider reimbursement decisions and strategies, including evaluations offinancial impact and implications on network adequacy.o Supports strategic analysis in the development of tactical implementation plans toachieve objectives identified by the Executive Leadership Team or Partnership Board.o Ensures alignment of provider reimbursement strategies with Partnership mission,policies and procedures, revenue, and various state initiatives.o Monitors reimbursement and policy changes and trends in healthcare market dynamics,both locally, statewide, and nationally, and provides recommendations related toapplicability to Partnership. o Collaborates with provider communities and internal stakeholders to provide value-added services to members and increase operational efficiencies within the Partnershiporganization.o Assists with documentation preparation required for internal and external audits, asdirected.o Supports provider rate negotiation efforts to ensure alignment with organizationalpolicy.o Evaluates contracted rates, contract language relevant to reimbursement, andreimbursement methodologies and conducts research and data analysis to resolvequestions related to rates, methodologies, Partnership policies and procedures, and Statedirectives as they pertain to reimbursement.o Supports implementation of contracted rates and collaborative relationships withproviders, the Contracting team, and all stakeholder business units, as appropriate.o Provides analytical and pricing expertise to support Partnership’s negotiation,implementation, and maintenance of managed care contracts.o Supports the drafting, evaluation, and negotiation of a wide variety of different payeecontract language as approved by Partnership leadership and in collaboration with theContracts team and relevant business units.o Monitors, maintains, and ensures the accuracy of a repository of current contract rates,exceptions, and reimbursement methodologies.o Tracks, evaluates, and collaborates to process provider rate requests and requests forLetters of Agreement in accordance with Finance leadership directives and Partnershippolicy.o Educates internal stakeholders regarding analysis related to provider reimbursement.o Communicates activities and/or issues identified relating to provider paymentnegotiation, issue resolution, and implementation to the Provider Payment StrategyManager or the Senior Director of Fiscal Policy and Strategy, as appropriate. ▪ Utilizes a variety of methods and models to evaluate the feasibility ofreimbursement methodologies, with duties including but not limited to:o Strategic data analysis, data mining, research, and synthesized reporting related toprovider reimbursement methodologies to inform executive decision making.o Financial analytics in developing and evaluating various models, such as risk-bearing arrangements, bundled payments, and population health strategies that willprovide members with the best appropriate care while safeguarding the use of publicfunds.o Identifies methods and models involving multiple variables and assumptions toidentify the implications, ramifications, and predicted results of a wide variety ofnew and revised strategies, approaches, provisions, parameters, and rate structuresaimed at establishing appropriate reimbursement levels.o Utilizes financial modeling to forecast the viability of various paymentmethodologies and ensure that provider reimbursements result in a value greaterthan actual payments.o Supports payment modeling and providing implementation support, includingcontract language development and interpretation, in partnership with Contractingstaff.o Utilizes business intelligence tools and financial applications to facilitate analysis ofreports. ▪ Provides support as a subject matter expert related to the provider reimbursementfunction and provides guidance on departmental operations, with duties including butnot limited to:o Provides day-to-day subject matter expertise, responding to internal and/orexternal stakeholder inquiries, and participates in and contribute