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Kaiser Permanente Careers

Insurance & Claims

Delivery You Can Count On

As a member of our Claims Connect team, you'll help process and deliver the claims information Kaiser Permanente's members, providers, regulators, and customers need, and expect, from a world-class health care organization.

Sr. Contract Specialist/Analyst - CO

Location: Aurora, CO Job Number: 880429 Date posted: 06/22/2020

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Description:

Create and model terms of contracts, including full financial analysis and review of organizational impact. Partners with contract manager to develop contracting strategy and supports all aspects of the contract negotiation process. Conducts multiple types of contract analytic modeling, e.g. physician, ancillary, or hospitals. Supports a full range of contract arrangements and pricing mechanisms. Compiles healthcare claims data and other related information regarding provider contracts and provides recommendations to KP leadership to optimize strategy and performance. Educating and advising the department managers on the relationship of processing reports; trouble shooting, resolving problems, and reconciling unit cost areas, including providing written analyses, explanations and interpretations of all aspects of the contract performance.




Essential Responsibilities:



  • Leader in the evaluation and implementation of contract modeling software.

  • Perform sophisticated retrospective and pre-negotiation data analytics to support defensible pricing strategies.

  • Compare various contract scenarios.

  • Evaluate financial impact of proposed rates.

  • Develop post-implementation payment accuracy review.

  • Financial management and evaluation of ancillary (non-hospital) contracts ($200M +).

  • Create and maintain contracting models, reports & dashboards; prepares ad hoc reports upon request.

  • Leads contract modeling system development and implementation of process improvements.

  • Participates in Contract Negotiation Meetings.


  • Participates in Contract Negotiation Meetings.


  • Research and respond to inquiries from business units and stakeholders.

  • Educates contract negotiator on contracting analytics from a financial impact perspective.

  • Provide training and guidance for less experienced staff.

  • Preparing and presenting various financial contract analysis and performance, reports, and analyses related to the assigned function, which may include: unit cost reports, financial analytics, and other Health Plan leadership.

  • Other duties as assigned.



“Salary Range:  $42.12/hour - $49.52/hour”



Basic Qualifications:
Experience
  • Minimum of five (5) years of experience in health care data analysis including database/data mining experience including, but not limited to, creating queries, reports, and tables.
  • Minimum of two (2) years' experience using statistical analysis and healthcare modeling systems required.
  • Education
  • Bachelor's degree in business, mathematics, statistics, data science, healthcare administration or related field.
  • License, Certification, Registration
  • N/A

  • Additional Requirements:
  • Effective, clear and concise communication using appropriate channels to maintain working relationships.
  • Ability to meet very aggressive deadlines and solid analytical skills.
  • Experience creating multi-functional databases.
  • SQL and data warehouse experience.
  • Intermediate MS Excel computer proficiency test with a passing score of 70% or better.

  • Preferred Qualifications:
  • Minimum of seven (7) years' experience with provider data analysis and health care operations experience preferred.
  • Minimum of three (3) years working with robust database programs to include SQL & SAS preferred.
  • Experience with data marts, data mining tools and programming.
  • Cost accounting capability & understanding.
  • Experience with modeling systems and a working knowledge of process and procedures.
  • Ability to assist in migration to new data platforms & systems.
  • Experience with hospital charge masters, understanding of how to adjust charges and impacts on reimbursement preferred.
  • Understanding of provider reimbursement preferred.
  • Master's Degree in business, mathematics, statistics, data science, healthcare administration or related field.
  • Primary Location: Colorado,Aurora,Waterpark I Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: Varies Working Hours End: Varies Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-CO-02|NUE|Non Union Employee Job Level: Individual Contributor Job Category: Insurance / Claims Department: NDPC Travel: Yes, 10 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

    Learn About Insurance & Claims Careers

    Careers in Insurance & Claims

    Our insurance and claims teams are committed to meeting customer and member expectations when it comes to the timely and accurate processing of claims, while remaining in compliance with federal, state, and local laws, as well as regulations and rules. Make an impact as you contribute to the implementation of contemporary technology in areas such as claims quality, claims operations, business analysis, processing, configuration, reporting, and more.

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