Payer Contracting Analyst , Value Based Care

About the position

Be a part of a world-class academic healthcare system at UChicago Medicine as a Contracting Risk Analyst - Value Based Care for the Finance Managed Care department. This position will be primarily a work from home opportunity with the requirement to come onsite as needed to the Hyde Park or Burr Ridge location. You may be based outside of the greater Chicagoland area. The Contract Risk Analyst - Value Based Care is responsible for analyzing and modeling Value Based Care (VBC) and population health risk agreements on behalf of the Office of Managed Care (OMC) and the UChicago Medicine Clinically Integrated Network (CIN), including but not limited to Medicare Advantage, Medicare CMMI Accountable Care Organizations (ACOs) for shared savings (MSSP and ACO Reach), Commercial ACOs, Bundled Payments, Capitation, Direct to Employer (DTE), and global risk agreements. Partners with the Contracting team (FFS and VBC), CIN and the clinical teams on evaluating VBC risk contracts, incentive programs and distribution, incentive funds flow, calculating and modeling projected financial risk performance (such as risk corridor scenarios, stoploss/reinsurance, feasibility, and scenario analyses). Analyst works with senior leadership to support future financial goals and strategies related to its entities, as well as modeling and forecasting. The analyst assists VP of Payer Strategy, OMC Directors and CIN leadership during risk-based contract negotiations to ensure successful contract negotiation and implementation, monitoring and enforcement of contract terms and support for value base care contracting initiatives and serves as a subject matter expert for risk based contract terms developing monitoring tools and reporting to proactively manage and mitigate risk and improve contract performance. Analyst monitors and reviews existing and new CMMI Government Programs (MSSP, etc) understanding the risk components and partnering with the Director, Value Based Payment Models and BI Analyst to assess feasibility and requirements for participation. Collaborates with interdisciplinary teams across the care continuum - Decision Support, Financial Planning, Budgetary, etc to support enterprise wide alignment and reporting around VBC programs. Actively embodies Mission, Vision, and Value of UCM.

Responsibilities

• Perform sophisticated VBC risk analyses including developing contractual risk models, financial and operational models and performance monitoring and evaluations.
• Responsible for VBC and CIN risk corridor and feasibility analysis, financial forecasts of upside/downside risk, determination of Stop-Loss, among other risk based contract terms.
• Creates financial models and forecasts that provide insight on mitigating potential losses and maximizing and optimizing financial performance under VBC contracts.
• Develops models for projecting and evaluating costs trends in risk contracts across enterprise.
• Supports development and maintenance of physician incentive models and payout distribution methodologies.
• Sources large integrated internal databases (Enterprise Data Warehouse, vendor sources data marts, etc) to develop analyses.
• Analyzes complex datasets to assess changes and opportunities in total cost of care, leakage and membership attribution.
• Work closely with the VP Payer Contracting and Director Value Based Payment Models to support all VBC contract negotiations for Managed Care Commercial payers, Direct-To-Employer, Medicare Advantage payers and Medicaid payers to analyze, model and negotiate VBC contract risk terms for UCM hospitals and physicians.
• This includes assessment and identification of contract opportunities through implementation of the contract; negotiating and managing complex and innovative VBC risk methodologies striving to maximize performance and incentive opportunities.
• Works with OMC and CIN teams on monitoring of current internal performance and analysis of VBC risk contracts by creating standard internal reporting that monitors current performance and forecasts future trends.
• Partners with internal and external department analysts on developing physician incentive reporting, as well as custom reporting that analyzes data for trends analysis and interpreting medical patterns to uncover opportunities in risk performance.
• Supports subcommittee report outs on active risk-based programs.
• Create reports of contract outputs, historical trends, and opportunity analyses as needed for OMC, CIN, and senior leadership.
• Continued education on ever-changing VBC program rules and policy updates both commercial and governmental that impact expected performance contract profiles and education of internal stakeholders on risk and performance terms, methodology and impacts as needed.

Requirements

• A Bachelor's degree in Business, Finance, Healthcare, or related field, or a combination of relevant education and experience.
• Advanced Degree in Finance based disciplines are preferred.
• Five or more years of experience in a multi-facility health system in either: Prior experience with value-based care (VBC)/alternative payment models.
• Five or more years' experience in multi-facility health system, large academic and community physician groups or clinically integrated network, large academic medical center or insurer environment.
• Requires detailed knowledge of hospital and physician complex value based care (VBC) risk reimbursement methodologies including shared savings, capitation, downside risk, % of premium, global risk and bundled payments.
• Requires detailed knowledge of hospital and physician complex VBC methodologies, particularly Value based care (VBC) risk reimbursement structure knowledge.
• Excellent understanding of risk based contracts.
• Demonstrated advanced technical skill and knowledge of healthcare EDW data systems and query languages.
• Experience in population health and value based care data repositories, third party software tools, and working with payer claims datasets.
• Requires familiarity and aptitude with risk contracts and associated payer and provider datasets, and modeling systems and/or cost accounting systems that build payer risk contract profiles.
• Ability to analyze and integrate complex internal and external datasets.
• Requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case for a recommended course of action.
• Excellent analytical and problem solving skills, and the ability to make decisions quickly and independently.
• Strong attention to detail and well organized.
• Adapts well to rapid change and multiple, demanding priorities with excellent time and project management skills.
• Ability to understand and interpret federal regulations and policies, coding guidelines and reimbursement changes.
• Interact effectively with colleagues in a variety of contexts and forums and contribute as a team player.
• Demonstrated ability to self-direct, multi-task and partner with technical staff from different departments.
• Microsoft Office Suite advanced proficiency also required, particularly Excel.
• Strong aptitude for learning additional software or systems as needed, particularly finance and revenue cycle billing systems.

Nice-to-haves

• Experience in the following areas: Risk programs analysis and reporting - including Medicare Advantage, Bundled Payments, and ACOs.
• Experience in supporting risk based contract negotiations.
• Experience with Health system data warehouses and datamarts.
• Knowledge and experience in VBC provider incentive distribution management programs and incentive funds flow preferred.
• Payer experience preferred.
• Experience with CMS CMMI governmental programs related to Medicare and Medicaid.
• Experience with payer compliance review including underpayment variances and denial management.
• SQL skills.

Benefits

• Flexible remote work options
• Comprehensive health insurance
• Retirement savings plan
• Paid time off
• Professional development opportunities
• Employee wellness programs