The Alliance is recruiting a contract and reimbursement analyst. In this position, you will be an integral member of the Provider Relations and Analytics departments, providing contracting staff with all of the information needed to help our member employers get maximum value for their healthcare dollars. Your work will aid complex contract negotiations by modeling proposed reimbursement arrangements to determine whether they meet the purchasing principles of The Alliance. You will also help providers understand our reimbursement methodologies and fee schedules by preparing rate analyses. Additionally you will translate large sets of healthcare data into meaningful reports that help The Alliance “move healthcare forward.”
The future of healthcare is changing, along with the way employers purchase services their employees consume. You can help influence that future by carefully monitoring reimbursement trends to identify the best strategies that transform how healthcare is purchased to include value based payment design, prospective healthcare purchasing, and alternative contract models.
Key responsibilities are:
- Performing prospective and retrospective contract modeling for professional and facility services, including inpatient/outpatient hospital and ambulatory surgery centers (ASC’s)
- Developing reimbursement recommendations for contracting staff to support contract negotiations
- Researching and recommending healthcare reimbursement strategies that help members control healthcare costs effectively
- Working with a large stores of external administrative healthcare data to develop reporting tools that evaluate provider-specific resource utilization and efficiency
- Working with other departments to identify contractual opportunities, improve operational efficiency and resolve problems
- Serving as a primary resource for questions related to facility coding and billing practices.
To excel in this role The Alliance seeks someone who has both attention to detail and a high degree of flexibility, due to the varying nature of the work. Other critical abilities include: self-direction, the ability to manage multiple priorities, strong written and oral communication skill, listening skills, and an innate desire to explore and solve problems and determine alternative solutions. Additionally well-qualified candidates will have:
- A bachelor’s degree, or equivalent experience
- A minimum of three years’ experience is required working with medical claims data to develop, analyze or negotiate contracted rates.
- A comprehensive understanding of billing and reimbursement for professional and facility services is required, including the role and use of CPT codes, DRG’s and Revenue Codes to represent healthcare transactions.
- Advanced proficiency in Excel and SQL to extract and manipulate data for use by others
- Data visualization skills
This position is eligible for telecommuting, in accordance with company policies and departmental needs. The Alliance is not able to provide visa sponsorship at this time.
The Alliance serves as the voice for self-funded employers who are tired of traditional health care and want more control over their costs. We provide transparent, creative approaches to network and benefit plan design to unlock savings where others can’t – or won’t – using Smarter Networks(SM) and sophisticated data mining and analysis. As a not-for-profit cooperative, The Alliance is employer-owned and remains a trusted, objective partner for employers and their brokers who seek improved access to high-quality healthcare.
We work with more than 275 employers across the Midwest and contract with over 34,000 health care providers and specialists in the region. Our goal is to help employers better manage their healthcare costs while emphasizing value and creating healthier, more engaged workforces.
The Alliance is celebrating 30 years as a mission-driven and member-focused collective with strong and proven sales, member services, marketing, customer service, technology and administrative teams. By joining The Alliance, you’ll be part of a passionate, collaborative, and supportive organization with high levels of employee engagement and satisfaction.
In this role you’ll be backed by a strong sales, member services, marketing, customer service, technology and administrative teams. You’ll be part of an organization with high levels of employee engagement and satisfaction. The Alliance is mission-driven, member-centered, respectful, and supportive of team members.
Equal Opportunity Employer.