Senior Value-Based Contracting & Reimbursement Analyst

SUMMARY:

Under general direction, the Senior Contracting and Reimbursement Analyst supports the negotiation, analysis, administration, and financial evaluation of hospital and physician value-based payor agreements. The role combines value-based contracting expertise and net revenue analysis.  The role ensures ensure value-based contracts are financially sound, operationally executable, compliant with governmental requirements, and aligned with the system’s strategy. The incumbent evaluates new and existing arrangements, including value-based and alternative payment models; prepares reimbursement analyses, cost report support, net revenue estimates, and financial forecasts; coordinates contract implementation and audit activities. Serves as a liaison among affiliates, finance, analytics, operations, and clinical stakeholders.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

Instill Trust and Value Differences
Patient and Community Focus and Collaborate

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Value-based Contract Negotiation and Administration

• Assists with payor relations and contracting leadership with hospital and physician negotiations.
• Evaluates new and existing value-based arrangements, bundled payment models, shared savings agreements, and other alternative payment models.
• Assists in coordination of timely contract execution, renewal, renegotiation, amendment, implementation, and distribution of relevant contract materials.
• Prepares and distributes value-based variance analyses, rate matrices, executive summaries, contract abstracts, and other documentation required to communicate financial and operational terms to affected parties.
• Acts as a liaison to health plans, system affiliates, physician organizations, finance, operations, legal, analytics, and other stakeholders regarding contract terms, implementation, and issue resolution.

Reimbursement, Net Revenue, and Financial Analysis

• Prepares and analyzes financial and statistical data required for governmental and third-party reimbursement reporting, affiliate and consolidated cost reports, net revenue schedules, month-end close, budgeting, forecasting, and settlement estimates.
• Analyzes reimbursement methodologies, contract rates, payment terms, rate calculations, final settlements, pass-through payments, advance payments, and payer remittances to identify underpayments, overpayments, financial risk, and opportunities for improvement.
• Quantifies estimated reimbursement from governmental and commercial payors and supports balance sheet and income statement adjustments for liabilities and receivables related to third-party settlements.
• Works closely with analytics and finance leadership to evaluate contract profitability, model financial impacts, monitor performance against contract terms, and develop methodologies to measure reimbursement changes.
• Prices governmental and third-party reimbursement for new or expanded clinical programs and coordinates financial studies related to new programs, product lines, service expansion, and contracting opportunities.
• Participates in development of the annual net revenue operating budget and related forecasts.

Regulatory, Audit, and Compliance Support

• Maintains current knowledge of commercial payor requirements and governmental reimbursement regulations and analyzes their financial, contractual, reporting, and operational impact.
• Prepares and assembles financial and statistical reports required by governmental agencies, third-party payors, auditors, and external advisors.
• Coordinates and supports third-party reimbursement and contract audits, responds to inquiries, assesses proposed audit adjustments, and communicates material issues to leadership.
• Recommends and develops analyses and action plans for appeals, disputes, payment variances, or other matters involving third-party and governmental payors.
• Supports contract and reimbursement quality assurance, audit readiness, internal controls, and compliance with established policies and procedures.

Performs other duties as assigned.

EDUCATION:

Bachelor's degree in accounting, finance, business, health care administration, or a related field, or equivalent education and experience.

Comprehensive knowledge of health care finance, reimbursement, managed care contracting, contract administration, accounting principles, net revenue, cost reporting, and financial analysis.

Knowledge of hospital and physician payment methodologies, capitation, risk arrangements, value-based contracting, alternative payment models, and governmental reimbursement principles.

Strong analytical, financial modeling, negotiation, communication, project management, and problem-solving skills.

Ability to interpret complex contractual, financial, regulatory, and operational information and communicate conclusions clearly to varied audiences.

Advanced proficiency with Excel-based financial models and database tools. Experience with Epic, EPSi, PeopleSoft, or comparable integrated financial systems preferred.

EXPERIENCE:

Three to five years of progressively responsible experience in a complex health care environment, with significant experience in managed care contracting, contract analysis and negotiation, third-party reimbursement, net revenue, financial reporting and analysis, budgeting, forecasting, cost reporting, or related areas. Demonstrated ability to work independently and manage multiple complex analytical and contracting priorities is required.

SUPERVISORY RESPONSIBILITY:

None.

Pay Range:

$78,416.00-$129,355.20

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type:

M-F (8:00am-5:00pm)

Work Shift:

Day

Daily Hours: 

8 hours

Driving Required:

No