| UW Medicine's mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow's physicians, scientists and other health professionals. UW Medicine owns or operates Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center, a network of UW Medicine Neighborhood Clinics that provide primary care, UW Physicians, UW School of Medicine, Airlift Northwest, and other owned, operated or affiliated entities as appropriate. In addition, UW Medicine shares in the ownership and governance of Children's University Medical Group and Seattle Cancer Care Alliance a partnership among UW Medicine, Fred Hutchinson Cancer Research, and Seattle Children's. |
UW Medicine Contracting & Payer Relations has an outstanding opportunity for a Contract Reimbursement & Predictive Model Analyst. This individual will be responsible for the contract analytics and performance based contracting, actuarial type analysis, data collection, SQL programming and reporting in support of payer contracting efforts. The Contract Reimbursement & Predictive Model Analyst will implement and maintain contract payment modeling systems. Assist in maintaining the pertinent data tables, fee schedules, contract terms and contract rules necessary for contract modeling. The modeling systems include, but are not limited to: McKesson Performance Manager (PM) and Advisory Board Payment Integrity Compass (PIC). Support the negotiation of contracts through analysis to completion, discusses contract requirements with clinical staff as necessary, and occasionally meets with key internal staff regarding contract issues to discuss a specific impact upon a specific department.
Act as an analytical subject matter expert on commercial and private government (i.e., MCO's and MA plans) contract reimbursement (primarily focusing on facility reimbursement), for leadership, performing ad-hoc analysis, providing data extractions and answering requests for improvement as needed. Assist Underpayments team as needed to interpret contract terms as they relate to reimbursement and give them tools to resolve issues with payers when they have been unsuccessful. Assist with reconciling payment data to financial statements, evaluating discrepancies for reasonableness, documenting and communicating changes to payment models to include distributing that information to end-users.
Perform monthly audits of modeling rules to ensure compliance with contract terms and changes in fee schedules, terms and policies that alter reimbursement. Perform analysis of contract performance including evaluation of payment variances, impact of contract proposals, identify payment methodology(s) suiting UW Medicine goals and proposal accordingly, impact of changes in government programs and product line profitability.
As part of a negotiation, validate data and proposal results with external parties, comparing data sets and calculations and identifying areas where agreement may be reached or alternatives developed.
Develop contract models outside of the PM and PIC systems to access the impact of new payment methodologies. Create and maintain monitoring reports for self and Patient Financial Services to verify, on a monthly basis, appropriate payments to include developing and monitoring policies and procedures that support the reports for coordination with Admitting, clinical areas, Accounting, and PFS to best utilize the provider contracts.
Serve as backup and assist Senior Analyst, Population Health with extraction, review and dissemination of population health reports from various payer software programs.
Provide training and "help desk" style support for other analysts and decision support users that include report generation, data presentation, and interpretation.
Respond accurately, timely and in a positive manner to any requests for data from customers. Maintain active relationships with customers and process partners by continuously assessing needs, preferences and levels of satisfaction with deliverables. Prepare ad hoc reports to respond to customer requests. Establish and maintain process documentation that is available to management.
Perform other duties as assigned.