Overview

St. Luke's Health Partners seeks a Network Reimbursement Analyst to join their team.

St. Luke's Health Partners (Health Partners or the Network) is a wholly owned subsidiary of St. Luke's Health System, and a financially and clinically integrated network of providers improving the health outcomes of the population and lowering the cost of care. Health Partners supports a healthy work-life balance and offers a dynamic environment whereby team members work cross-functionally and collaborate to drive its value-based care strategy.

The Network Reimbursement Analyst is responsible for performing provider reimbursement analysis, projections, and modeling to support payer and provider value-based care contracting decisions. This position provides a wide range of support to Health Partners related to payment policies, contract settlement, and fee schedule updates.

Responsibilities

• Performs complex analysis utilizing claims data and industry standard payment methodologies to model financial impacts of Network reimbursement changes. Analyzes and interprets financial data, discerns important trends that can be used by management for decision making.
• Develops, coordinates, and manages analysis accompanying existing and new reimbursement models, as well as provides analysis in the development and support of value-based reimbursement (VBR) projects and information required to make effective business decisions, and recommend innovative approaches to VBR models and programming.
• Leads the maintenance/maturation of in-market VBR models and the development of new VBR models partnering with internal stakeholders and aligning to broader organizational strategies and goals.
• Provides reporting of reimbursement impacts to be utilized in value-based arrangement contracting decisions and financial forecasting.
• Collaborates on the development and implementation of improved infrastructure and processes to provide the Network with regular performance scorecards highlighting initiative implementation successes and progress.
• Conducts post-claims audits for accuracy and compliance with the Network policies and arrangements.
• Responsible for tracking and communicating industry updates that impact reimbursement.
• Works collaboratively with interdisciplinary team to ensure understanding and adherence to standards of practice and relevant policies and procedures for areas of oversight.
• Serves as a liaison among internal and external customers, including but not limited to VBR team members, operations, provider relations, strategic integration and advanced analytics and reporting.

Qualifications

Education: Bachelor's Degree or 4 years' experience in lieu of degreeExperience: 4 years relevant experience. Relevant experience includes but is not limited to:

• analyzing large amounts payer data
• experience with and/or knowledge of healthcare reimbursement methodologies/healthcare coding
• reimbursement process modeling
• experience with and understanding of individual payer practices and how it impacts the health system and independent stakeholders (e.g., telehealth reimbursement)
• Auditing payer claims adjudication to ensure the fee schedule is being followed and have the ability to troubleshoot and communicate concerns/issues between payers and providers

Why St. Luke's

A strong, talented staff is at the heart of St. Luke's Health System. We are the state's largest employer with more than 15,000 employees and a medical staff of more than 1,800 physicians and advanced practice providers. We're proud of our people who deliver skilled, compassionate care every day, and are looking to add dedicated individuals who will continue this same tradition of excellence.

*St. Luke's is an equal opportunity employer without regard to race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.