Provider Data Analyst

Let’s do great things, together

Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together.

Currently, Moda Health is seeking a Provider Data Analyst to conduct analysis to support contract negotiations with medical providers. The analyst uses claims data, as well as other data sources, to model the impact of various contract terms. Functions include the use of analytic tools to pull data from Moda’s data warehouse, analysis that converts the raw data into useful information, and analytic summaries that communicate the information to the department’s “customers”.

As a key player on the Provider Analytics team, you will take a leadership role in designing analytic models, collaborating and strategizing with the contract negotiator, and communicating analytic findings.

Primary Functions

Model current and proposed contract terms, using claims data, in order to calculate the bottom line impact of those terms.
Conduct analysis related to provider contract renewals, including market research and competitive analysis.
Communicate analytical results to contract negotiators and to Moda’s executive team.
Act as an internal consultant to the contract negotiating team providing advice on Medicare guidelines, reimbursement methodologies, and Excel models.
Audit contracts to ensure that reimbursement terms were interpreted and implemented correctly.
Evaluate the impact of new reimbursement methodologies on current provider billing practices and recommend strategies to mitigate unintended effects.
Build and maintain new analytic tools, as needed, for contract modeling and analysis.
Collaborate with other analysts, sharing knowledge and information through formal presentations, team meeting discussions and informal conversations.

Are you ready to be a betterist?

If you’re ready to make a difference that matters, we want to hear from you. Because it’s time to discover what’s possible.

Together, we can be more. We can be better.

Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law.

1. Minimum of 5 years of experience in healthcare analytics working on either the provider or payer sides of health care
2. Strong working knowledge of physician, hospital, and ambulatory surgery center billing
3. In-depth knowledge of the healthcare industry including billing and claims, medical coding, payer/provider relations, contracting processes, fee schedules and reimbursement methodologies, national and local healthcare trends and hospital and clinic operations
4. Demonstrated competency in analyzing various contract terms such as RBRVS-based reimbursement; DRG and APC-based prospective payments; fee schedule-based reimbursement such as ASC, clinical laboratory, DME, and pharmacy. Experience with multiple various contract types such as capitation, per diem, and case rates.
5. Ability to interpret contract terms and translate terms into financial models.
6. Experience with analytic/decision support tools, SAS Enterprise Guide experience preferred
7. Ability to use solution-focused problem solving and to think through problems creatively
8. Ability to work independently, to take initiative, identify problems, use root cause analysis, seek out solutions and make recommendations.
9. Ability to learn new concepts quickly and to apply those concepts in everyday work situations.
10. Ability to communicate analytical findings in a clear, concise manner in both verbal and written form
11. Strong customer focus; experience with Lean Processing and/or continuous performance improvement is a plus
12. Advanced Excel skills with strong knowledge of formulas such as VLOOKUP, SUMIFS, SUBTOTALS, RANK, etc
13. Experience using Microsoft Access preferred
14. High-level knowledge of accounting and finance concepts
15. Demonstrated interest in the healthcare industry
16. Ability to multi-task and prioritize
17. Bachelor’s degree in healthcare management, business administration or related field; MHA, MPH or MBA preferred