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Commonwealth Care Alliance Senior Analyst, Provider Reimbursement in Boston, Massachusetts

Why This Role is Important to Us

CCA is an integrated care delivery organization that is expanding to support our mission to "improve the health and well-being of people with significant needs by innovating, coordinating and providing the highest quality, individualized care." "Our vision is to lead the way in transforming the nation's healthcare for individuals with the most significant needs."

Working within CCA's Actuarial and Medical Economics department, the Senior Analyst, Provider Reimbursement will provide ad hoc analytics to support provider contracting discussions and strategic partnerships. The position will work collaboratively with the provider network strategy department to develop tools and reporting infrastructure to monitor provider network performance, support organizational decision-making, and identify opportunities to improve quality and control costs. This function is of critical importance as CCA continues to expand its footprint into new markets and contracts with new network providers.

Supervision Exercised: No

What You'll Be Doing

  • Using Excel, SQL, Access, Milliman MedInsight/Repricer tools, or other data analysis tools, develop analyses and reports to support CCA decision making related to provider contracting

  • Develop ad hoc models of varying levels of complexity to support provider contract negotiations and strategic partnership discussions.

  • Support research and analysis using regulatory guidance, government data and statistics,

reports, publications, and other publicly available data sources to inform network development activities and decision-making

  • Support collaboration between contracting and other internal stakeholders related to the identification and implementation of quality-improvement and cost-savings initiatives

Working Conditions: Standard office conditions.

What We're Looking For

Education Required:

  • Bachelor's Degree or equivalent experience

Experience Required:

  • 2-3 years of experience with provider contracting, health care reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare)

  • Experience with health care claims data and risk adjustment methodologies (e.g., DRG, RVU, CMS HCC, etc.), actuarial models and forecasting

Experience Desired:

  • Experience using Looker, Tableau, or other visualization software

Knowledge, Skills, & Abilities Required:

  • Strong analytical skills and familiarity with common data analytics tools, including Excel, Python, R, SAS, SQL, or other analytical tools

  • Strong work ethic: able to solve problems and overcome challenges

  • Well organized and able to work on multiple projects simultaneously

Knowledge, Skills & Abilities Desired:

  • SAS, VBA

  • Milliman MedInsight/Repricer

Language(s) Required:

  • English
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