Senior Financial Analyst, Health Plan Finance (Hybrid)

Quest Diagnostics - Secaucus, NJ

Full-time - Mid Level

Secaucus, NJ

Ambulatory Health Care Services

About the position

The Senior Financial Analyst plays a crucial role in supporting the financial and operational evaluation of prospective Health Plan contracts at Quest Diagnostics. This position is integral to ensuring the growth and profitability of third-party payors by providing consulting and recommendations based on thorough financial analyses. The analyst will work closely with various departments, including Health Plan Sales, Regional Finance, and the Health Plans Finance Contract Support Manager, to respond effectively to contract proposals for both regional and national contracts. In this role, the Senior Financial Analyst will perform comprehensive financial analyses required for prospective third-party contracts. This includes compiling fee schedules, projecting revenues, conducting synergy analyses, and developing 'what-if' scenarios to assess potential outcomes. A key responsibility will be calculating specific CAP PMPM rates and developing CPT-based fee schedules for significant contracts. The analyst will also develop utilization and membership corridors, integrating these into contracts to mitigate the company's risk in capitated arrangements. The position requires collaboration with the Clinical Franchise department to ensure that pricing guidelines for high-value and new test campaigns are factored into prospective contracts. The Senior Financial Analyst will serve as a content expert for regional leadership, providing insights on pricing strategies and the implications of price, volume, and costs associated with new and existing contracts. Additionally, the analyst will work on streamlining the pricing review and authorization process for third-party contracts and perform analyses on specific test campaigns to evaluate their revenue and volume impact. Supporting the annual budget process is another critical aspect of this role, where the analyst will provide detailed insights on known and potential contract changes for the upcoming year. The position may also involve ad-hoc projects as needed, requiring a flexible and innovative approach to problem-solving.

Responsibilities

• Support the financial and operational evaluation of prospective Health Plan contracts.
• Perform all financial analyses required for prospective third-party contracts, including fee schedules and revenue projections.
• Calculate specific CAP PMPM rates and develop CPT-based fee schedules for key contracts.
• Develop utilization and membership corridors to protect the company from downstream risk.
• Support the development of standard premium priced tests and overall pricing guidelines.
• Collaborate with the Clinical Franchise department on pricing guidelines for new test campaigns.
• Serve as a content expert to regional leadership regarding third-party contracts and pricing strategies.
• Interface with regional leadership on price, volume, and cost implications of contracts.
• Streamline the pricing review and authorization process for third-party contracts.
• Perform analyses to determine revenue and volume impact for key test initiatives.
• Partner with the Billing function to enhance third-party data for financial models.
• Support the annual budget process with insights on contract changes.
• Handle ad-hoc projects as needed.

Requirements

• Bachelor's degree in a relevant field.
• A minimum of three years of relevant financial analysis experience.
• Strong understanding of the healthcare industry and health plans.
• Strong financial and analytical skills.
• Innovative thinker comfortable with ambiguity.
• Ability to work effectively cross-functionally in a matrix environment.
• Excellent verbal and written communication skills.
• Ability to work independently and within a team.
• Strong PC skills, including Excel, Access, PowerPoint, and Word.