Department Overview

The purpose of this position in OHSU Hospital Financial Services is to provide advanced financial analysis and modeling for hospital and physician rate-setting and profitability reporting related to third-party payor contract negotiations with insurance companies, government agencies, and other external entities for OHSU Healthcare and its affiliated organizations.

This position is responsible for contract coding and system maintenance for the Epic Contract Management Systems (CMS) and the review of all content and coding provided by the external JDA (Parathon) and Experian contracting systems.

This position is responsible for various hospital and physician net revenue impact analysis projects as directed by OHSU managers and administrators. This is one of four Managed Care Analyst positions in the Rates and Payor Contract Analysis section of Hospital Financial Services serving OHSU Healthcare, Hillsboro Medical Center (HMC), and other OHSU affiliated organizations.

This position completes ad hoc financial projects and reports as needed.

Function/Duties of Position

1. Develop managed care contract rates, lead analytical support for decision-making during hospital and physician contract negotiations, and provide payor performance and variance reporting for all third-party payor contracts. Complete advanced financial analysis and modeling of patient charges and costs to include the following:

• Database retrieval, including creation and use of complex Webi and other queries against the Data Warehouse. Perform validation and organize patient information for contract models.
• Build complex financial models and perform scenario analyses of payor reimbursement using patient data and contract terms. Analyze the impact of counter and final proposals.
• Develops summary presentations of rate proposals for executive leadership with explanations and recommendations.
• Develops payor performance reports of charges, cost, and profitability to leadership.
• Monitor and analyze variances between negotiated contract payment terms and contract performance to ensure actual reimbursement is consistent with expected payment calculations. Report findings of collection issues to leadership, and provide alternative recommendations for future contract terms or methodologies.
• Maintain contract rates and terms databases and tools.
• Researches commercial payor policy changes and provides net revenue impact analysis and recommended response to Managed Care Contracting (MCC) leadership.
• Researches state and federal regulatory and legislative changes and provide net revenue impact analysis to MCC and hospital leadership.
• Develop and maintain a working relationship with MCC to facilitate timely responses to contract proposals and other rate-setting contracting priorities.

2. Codes government and commercial payor contract terms and maintains EPIC Contract Management System (CMS). Monitors and validates payor contract coding for external JDA Parathon CMS.

• Analyzes government agency regulations and third-party payer contracts and converts reimbursement terms into EPIC contract management systems payment calculations with the use of system structure and schema.
• Works jointly with Managed Care Contracting, Patient Business Services (PBS), insurers, and government agencies to interpret and clarify payment terms, identify and resolve contract coding issues, and recommend contract language modifications to secure accurate expected reimbursement.
• Responsible for the maintenance of quarterly and annual government statistical metrics necessary for the accurate calculation of expected reimbursement in the 3M Grouper Plus software and EPIC master tables.
• Serves as Hospital Financial Services contact for IT-related system upgrades, fixes, and troubleshooting for EPIC CMS.
• Serves as contact for OHSU EPIC system contract coding and system modeling. Coordinates with the OHSU billing department to troubleshoot and monitor coding and collection issues.
• OHSU JDA contract coding, modeling, and database issues for JDA CMS. Coordinates with OHSU PBS, ITG, and JDA to troubleshoot and monitor interface issues and fixes.

3. Completes ad hoc financial projects and analyses as assigned by their manager or other HFS leadership. Develops and maintains procedure documentation that relates to this position.

Required Qualifications

• Bachelor's degree in Accounting, Finance, or a related field from an accredited college or university. If from a related field, the candidate must have 18 hours of accounting courses from an accredited college or university.
• All candidates must have 4 years of professional healthcare and/or relevant financial analysis experience.
• Highly proficient with the use of computers, including database and spreadsheet applications (e.g. pivot tables, macros, and embedded formulas).
• Excellent oral and written communication skills.
• Ability to use tact and diplomacy to maintain effective working relationships inside and outside OHSU.
• Ability to work effectively in a team-based environment.
• Ability to work independently and to exercise sound judgment.
• Ability to be detail-oriented including accuracy with numbers and data retrieval.
• Ability to track a large number of different tasks through various stages of development and implementation.
• Ability to complete projects within specified timeframes.
• Demonstrated reliability and successful performance from past work history.
• Must be able to perform the essential functions of the position with or without accommodation.

Preferred Qualifications

• MBA, MHA, or other related graduate degree preferred.
• 5 years of Hospital, Physician, and Payor financial analysis experience including knowledge of managed care rate-setting concepts, understanding of contract negotiation process, knowledge of commercial and governmental reimbursement principles and terms, and understanding of hospital billing and government payment methodologies.
• Experience with EPIC, JDA Parathon, and/or Experian contract modules, specifically as it relates to patient billing and contract modeling and coding.
• Experience with SQL query writing and use.
• Experience in Financial Reporting software (Axiom\SRC, Business Objects\Webi, Cognos, etc.)

Additional Details

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All are welcome