Payer Analytics Associate

Job Description Overview

Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.

As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge:

• We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business.
• We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care.
• We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients.
• We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.

The new SCA Health represents who we are today and where we are going—and the growing career opportunities for YOU.

Responsibilities

SCA Health is currently seeking a Payer Analytics Associate with Physician Practice Managed Care experience on the Catalyst Analytics team. We are seeking a candidate who is excited to take a thoughtful approach to examine and organize complex data for multiple physician specialty practices. Moreover, we are seeking an analyst with an investigative mindset to explore nuances of the data and use data to drive decisions through report preparation and analysis.

This position will be remote.

Responsibilities:

• Partner with specialty practice contracting team to identify key variables for upcoming fee for service and capitation negotiations, then generate accurate and instructive models that reflect these inputs
• Understand and become an expert on the structure and intricacies of incoming data sources. Communicate with team members and collaborators to understand unfamiliar/ambiguous data, as well as explore data thoroughly
• Audit capitation report and review physician claims data to ensure the rates/payments are collected according to the health plan contracts
• Interpret risk pool arrangements and summarize risk pool and incentive
• Understand and analyze monthly capitation payments made to network providers; identify and investigate unusual fluctuations and determine root cause of potential problems
• Support cross-functional team members with development, implementation, and maintenance of operational reports and analytical dashboards
• Collaborate with specialty practice development leaders to evaluate potential physician group acquisitions, using a combination of external and internal claims data
• Develop effective quality control processes to ensure data integrity
• Assist in building the Managed Care budget for future years together with Payer Engagement contract negotiators
• Present ideas and participate in meetings - Actively seek new opportunities to contribute
• Retrieve, organize, and manipulate data from the Enterprise Data Warehouse and other databases to prepare data for reporting and analysis. Deliver actionable, supportable findings within tight deadlines and changing requirements.
• Uphold and practice the principles and policies of the SCA Compliance program

Qualifications

• Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics or related field
• 5+ years analytical experience, or 3+ years of analytical experience in a Healthcare/Managed Care environment required
• Travel to health plan meetings, company meetings, center visits, etc. (10%)
• Experience in hospital, health plan, risk-based care delivery organizations or physician claims analytics
• Experience working with large healthcare claims data
• Clinical code knowledge (ICD, CPT, Rev Codes, etc.) related to medical claims/utilization data strongly preferred
• Advanced experience in Excel required
• MS SQL Server (Strong command over T-SQL) required
• Tableau BI tool experience preferred
• Acute attention to detail and strong analytical and critical thinking skills
• Experience with managed care contract terms analysis
• Experience in physician compensation, billing, capitation, risk adjustment, CPT coding, and resource-based relative value scale (RBRVS)
• Strong written and verbal communication skills including the ability to communicate results of data analysis to a variety of stakeholders

Must have experience with capitation as well as Managed Care Contracting.

USD $67,800.00/Yr. USD $120,000.00/Yr.

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