Summary

Position Summary

The Payor Strategy Analyst will be responsible for providing analytic support to aid in the negotiation, implementation, and ongoing maintenance of contracts for Spartanburg Regional Healthcare System, South Eastern Health Partners, and Regional Health Plus. The Payor Strategy Analyst is involved in a variety of project work, which will include gathering, modeling, validating, and analyzing data to produce reports and dashboards to aid Payor Strategy and senior leadership in strategic decision making.  This position requires the ability to understand complex concepts, use strong technical skills, and hold the ability to work as a part of a team in a matrix environment. The Payor Strategy Analyst should demonstrate innovative and critical thinking with creative approaches to solving problems.

Minimum Requirements

Education

• High School Graduate or higher. In 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.

Other Knowledge, Skills, and Abilities

• Knowledge of healthcare operations, managed care, health/insurance benefit plans, and revenue cycle systems.
• Intermediate to advanced knowledge of Microsoft Excel, PowerPoint, Power BI, and Strata Contract Modeling, or other database/report writer software.
• Ability to distill data to meaningful information, provide recommendations, and present findings of all analyses in a logical, concise manner in the required format.
• Preferably a working knowledge and understanding of hospital and physician reimbursement methodologies.
• Familiarity with developing and refining financial models based upon implied assumptions.
• Familiarity with EPIC, Strata or other contract management systems is preferred.

Core Job Responsibilities

• Identify revenue enhancing opportunities through data analysis, financial interpretation of contract terms, contract modeling, financial analysis, and data validation.
• Utilize Strata, Power BI, Excel, and Epic to develop monthly Payor Strategy and Population Health reports, including dashboards, and financial and utilization trends for SRHS, SEHP and RHP providers.
• Assist in contract negotiations by completing financial impact analysis of contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of proposals for future years, and developing alternative proposals.
• Work closely with the Manager of Payor Strategy, and the Director of Payor Strategy throughout the contract negotiation process to prepare, analyze, develop, and implement SRHS’s negotiated contracts.
• Assist the Manager in producing reports for Payor Strategy Council, RHP Contract Committee, RHP Population Health Committee by utilizing Payor Strategy Databases and reports/data provided by Payors as directed by Director of Payor Strategy or SVP Population Health.
• Organize and maintain physician reimbursement schedules and matrices.
• Perform analysis on managed care reimbursement to ensure compliance of contracted terms and to understand payment patterns of commercial and government contracts.
• Under the direction of the Manager of Payor Strategy, work closely with other SRHS corporate functions, including but not limited to Finance, Revenue Cycle, and Quality Management to provide sound strategic and tactical recommendations for SRHS strategic pricing initiatives.
• Research changes relating to managed care payor policies and determine financial impact to the health system.
• Develop thorough knowledge of the commercial payor community including M&A and performance research.
• Analyze the financial impact of existing and proposed contracts and performance programs between SRHS, SEHP, RHP, and Payor organizations.  Present findings and make proposal recommendations during negotiation process.
• Build analytical models to evaluate financial impact of various pricing initiatives.
• Work with Manager of Payor Strategy and the Director of Payor Strategy on analysis of annual charge master increases and implementation of resultant pricing changes.
• Participate in and provide financial reports to internal and external stakeholders as required by Manager and Director of Payor Strategy.

Don’t miss this opportunity to contribute to the success of Spartanburg Regional Healthcare System. Apply today and embark on a fulfilling career path with us!

Additional Information

Spartanburg Regional Healthcare System (SRHS) offers a full spectrum of services through six hospital campuses: Spartanburg Medical Center, Spartanburg Medical Center — Mary Black Campus, Pelham Medical Center, Cherokee Medical Center, Spartanburg Hospital for Restorative Care and Union Medical Center. SRHS also includes Ellen Sagar Nursing Center and Woodruff Manor. SRHS provides unparalleled cancer care through Gibbs Cancer Center & Research Institute, with locations in Spartanburg, Greer, Union and Gaffney. The multidisciplinary Medical Group of the Carolinas has more than 600 physicians across Upstate South Carolina and western North Carolina. SRHS employs more than 9,000 associates and offers outpatient surgery centers and a Level I Trauma Center.

Founded on Aug. 29, 1921, as Spartanburg General Hospital, Spartanburg Regional celebrates over 100 years of excellence.

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