Job Summary:
The State Market Intelligence Analyst IV investigates opportunities for contracting improvements and quality affordable initiatives (QAI) with existing partners, identifies areas for operational optimization, identifies issues related to reimbursement and recommends appropriate solutions.
Essential Functions:
- Investigates opportunities for reimbursement improvements with existing lines of business
- Identify issues related to reimbursement and recommends appropriate solutions. Includes generating and analyzing queries or reports for analysis
- Proactively collaborates with all teams to support contracting decisions, reimbursement policy alignment and resolution of complex reimbursement issues
- Provides strategic direction to support Enterprise/Market QAI strategies
- Identify and translate into action plans industry best practices for provider reimbursement, including fee schedule methodology, structure, modeling, and reporting
- Develops and provides actionable recommendations to senior management relative to all analysis and/or ad hoc reporting
- Ensure all governing body regulations are adhered to at all times for existing and future lines of business
- Build and strengthen internal relationships by facilitating quality service
- Ensure integrity of information obtained for analysis; keep up-to-date knowledge of the technical systems, claims processing initiatives, and CareSource payment policies for all products
- Evaluate appropriate solutions throughout the market and, as needed, assist with the deployment of those solutions into the organization’s workflow
- Participate in various analytic studies that establish CareSource as a leader in analytics regarding the healthcare status, needs or delivery results of our membership
- Assist with leading the efforts identifying trends and variances and identify in-depth cause-effect relationship between seemingly unrelated components, culminating in some public publication and/or presentation of the findings
- Perform any other job duties as requested
Education and Experience:
- Bachelor’s degree or equivalent years of relevant work experience is required
- Masters or other advanced degree in related field preferred
- Minimum of four (4) years of experience in finance, accounting, or other professional role with a focus on data manipulation and analysis is required
- Provider contracting experience is preferred
- Managed Care or healthcare experience is preferred
Competencies, Knowledge and Skills:
- Ability to understand complex systems and interdependencies
- Expert proficiency level with Microsoft Excel
- Advanced proficiency with Microsoft Suite to include Word, Power Point and Outlook
- Intermediate knowledge of SQL, SAS, R, or other data manipulation software
- Ability to work independently and within a team environment with limited guidance
- Ability to effectively report data, analyze facts, and exercise sound business judgment when making recommendations
- Ability to analyze problems, draw conclusions, develop processes and communicate status and results
- Excellent oral and written communication skills
- Ability interact with management as well as external stakeholders
- Ability to systematically review other's work
- Strong interpersonal skills and high level of professionalism
- Strong problem solving skills and attention to detail
- Effective listening and critical thinking skills
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for long periods of time
Compensation Range:
$79,800.00 - $127,600.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
