Payor Strategy Analyst

Position Summary

The Payor Strategy Analyst will provide analytic support to payor related contracting activities and provide support to the development of Spartanburg Regional’s managed care strategy.

Minimum Requirements

Education

• High School Graduate or higher. In the lieu of more than 7 years of experience in a similar role, the degree requirement can be waived.

Experience

• Minimum of 5 years of experience in healthcare or health insurance field.

License/Registration/Certifications

• N/A

Other Knowledge, Skills, and Ablilities

• Knowledge of hospital operations, health/insurance benefits plan, and revenue cycle systems.
• Intermediate to Advanced knowledge of Microsoft Excel, PowerPoint, SQL, Power BI, and Strata Contract Modeling

Core Job Responsibilities

• Load the contract terms in Strata and responsible for implementing any changes to those contracts in Strata.
• Support contract negotiations by developing Physician Contract Modeling.
• Prepare Medicare comparison Payor reimbursement reports for Physicians.
• Create and manage various payor matrices for internal as well as external use.
• Manage the Center of Excellence (COE) contract matrix.
• Responsible for creating and managing the Physician claims database to support contract modeling and RHP’s withhold process. Works with RHP practices to accurately collect claims information monthly.
• Accurately checks/enters enrollment, claims and withholds payments.
• Produce monthly Payor Strategy Dashboard data reports
• Develop and maintain the Payor Strategy payor reimbursement matrices for Hospital, Physician and other ancillary providers.
• Run hospital contract negotiation financial models in Strata to support contract negotiations. 
• Review RHP withhold process and provide recommendations to Manager for improvements.
• Produce timely and accurate reports for Quality and Population Health as requested.
• Produce Ad hoc reporting and analysis as requested by Manager that requires problem solving and critical thinking skills.
• Work collaboratively with SRHS Finance, Revenue Cycle and RHP departments on various projects assigned by Manager or Director from time to time.
• Prepare and effectively present results to senior leadership, and other key stakeholders for review and decision-making activities.
• Other duties as assigned.