Provides financial analysis and contract modeling support for managed care contracting leaders. Retrieves reimbursement data, evaluates payer methodology proposals, interprets contracts, validates financial models, performs monthly data-load quality assurance, and prepares analytical reports. The role requires expertise in hospital and physician reimbursement methodologies, billing and coding terminology, healthcare product lines, Excel, and contract modeling systems.
Job Summary
Provides data retrieval / contract modeling / financial analysis support to Director, VP, and Managed Care Regional Contracting Directors.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Retrieves reimbursement data from hospital and physician accounting systems.
- Builds financial models to analyze and evaluate the reimbursement impact of hospital and physician payer reimbursement methodology proposals
- Works with Managed Care Regional Contracting Directors on contract interpretation issues to ensure accuracy of contract models and financial analysis.
- Produces clear and concise written reports summarizing payment modeling analysis.
- QA monthly data loads.
- Completes special projects/reports as needed
Qualifications:
- Well versed in reimbursement methodology including DRG, APC, COPPS, OPPS, Case Rates, Per Diems, HCPCS and CPT Code Fee Schedules (2-5 years’ experience).
- Familiar with hospital and physician billing and coding terminology including diagnostic codes, revenue codes, procedure codes, and HCPCS codes.
- Well versed in healthcare product lines including HMO, PPO, HIX, Medicare, Medicaid, Tricare, Workers Comp.
- Must be able to clearly communicate complex and technical issues in writing and verbally.
- Must have the ability to work independently and manage multiple projects simultaneously
Computer Skills:
To perform this job successfully, an individual should have knowledge of
- Word Processing software
- Exceptional skills in Excel.
- Knowledge of contract modeling systems such as FinThrive preferred.
- Knowledge of Access or SQL preferred.
Education/Experience:
- Bachelor’s degree required; emphasis in Accounting or Data Analytics preferred
- 2-5 years’ work experience required
- Prior experience in hospital, physician or health plan financial analysis, or equivalent experience preferred
- Knows/has modeled/worked with health plan/hospital and physician managed care commercial and Medicare reimbursement methodologies and terminology
Similar Jobs
Cloud • Computer Vision • Information Technology • Sales • Security • Cybersecurity
Manage data center financial operations through budgeting, variance analysis, financial modeling, month-end close reporting, cost-saving initiatives, and strategic analysis. The role requires data warehousing and modeling expertise, hardware and asset-management understanding, process improvement, automation, and effective communication with leadership and cross-functional partners.
Top Skills:
Artificial IntelligenceData ModelingData WarehousingExcelMicrosoft Powerpoint
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Develop and manage financial analyses, reporting, forecasting, budgeting, and performance metrics. Partner with business leaders to communicate actual results, forecast performance, and variances, while identifying strategies to improve profitability and cost efficiency. The role requires financial planning and analysis experience, strong Excel and Microsoft Office skills, cross-functional collaboration, and the ability to anticipate and resolve accounting, reporting, and operational issues.
Top Skills:
Hyperion EssbaseExcelMS OfficePeoplesoftSnowflake
.png){kind=logo}
AdTech • Cloud • Digital Media • Information Technology • News + Entertainment • App development
Supports budgeting, forecasting, monthly close, financial modeling, variance analysis, allocations, accruals, headcount reporting, purchase order management, and executive reporting for Engineering Finance. Partners with operational and cross-functional teams globally, maintains financial processes, and improves reporting and analysis to support business decisions.
Top Skills:
CopilotEssbaseExcelMS OfficeMicrosoft PowerpointSAP
What you need to know about the Colorado Tech Scene
With a business-friendly climate and research universities like CU Boulder and Colorado State, Colorado has made a name for itself as a startup ecosystem. The state boasts a skilled workforce and high quality of life thanks to its affordable housing, vibrant cultural scene and unparalleled opportunities for outdoor recreation. Colorado is also home to the National Renewable Energy Laboratory, helping cement its status as a hub for renewable energy innovation.
Key Facts About Colorado Tech
- Number of Tech Workers: 260,000; 8.5% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Lockheed Martin, Century Link, Comcast, BAE Systems, Level 3
- Key Industries: Software, artificial intelligence, aerospace, e-commerce, fintech, healthtech
- Funding Landscape: $4.9 billion in VC funding in 2024 (Pitchbook)
- Notable Investors: Access Venture Partners, Ridgeline Ventures, Techstars, Blackhorn Ventures
- Research Centers and Universities: Colorado School of Mines, University of Colorado Boulder, University of Denver, Colorado State University, Mesa Laboratory, Space Science Institute, National Center for Atmospheric Research, National Renewable Energy Laboratory, Gottlieb Institute
