Sr Provider Network Analyst

<p><strong>With more than 8,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust. Interested in joining us?</strong></p>

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.&nbsp;

keywords: analysis,analysis,training,support,reporting,knowledge,experience,degree,analysis,reporting


Competitive Total Compensation Package

Overview: Responsible for analysis, evaluation, and development of provider risk arrangements and network development support activities, including; reporting, variance analysis, and settlement activities related to unique risk arrangements and compensation programs. Provide drill-down analytical capabilities utilizing FARE, Business Objects, SQL, and/or related analytical tools to support episode bundling initiatives, Key Performance Metrics and PFA cost reduction initiatives.
Responsibilities: <ul> <li>Develop analysis surrounding alternate risk and capitation models in support of new network product arrangements with provider groups.</li> <li>Creates reporting processes and provider settlement methodologies to increase efficiencies in annual provider risk settlement processes related to existing and prospective network arrangements.</li> <li>Provide evaluation and analysis as department lead on claims bundling initiatives working collaboratively with enterprise wide entities to achieve project outcomes.</li> <li>Complete drill-down analysis utilizing FARE to support PFA leadership, Provider Network Mgmt. and Medical Affairs cost reduction initiatives.</li> <li>Provide back-up support associated with monthly capitation processing, fund development, error correction and analysis, and system updates and projects in conjunction with provider capitation processes.</li> <li>Cross train on other departmental functions and participates in corporate committees and workgroups as required.</li> </ul>
Requirements: <ul> <li>Five (5) years managed care experience required including three (3) years systems analysis and two (2) years in provider contracting and risk arrangements.</li> <li>Bachelor&rsquo;s Degree in Business Administration, Healthcare Administration, Finance or Accounting required.</li> <li>Proficient knowledge of rating/underwriting principles and membership and an advanced understanding of provider risk/compensation processes required.</li> <li>Basic understanding of Facets configuration preferred.&nbsp;</li> </ul> <p><strong>DEPARTMENT REQUIREMENTS:</strong></p> <ul> <li>Demonstrated ability to develop analysis surrounding alternate risk and capitation models in support of new narrow network product arrangements with provider and physician groups.</li> <li>Demonstrated ability to create reporting processes and provider settlement methodologies to increase efficiencies in annual provider risk settlement processes related to new narrow network arrangements.</li> </ul> <p><strong>DEPARTMENT PREFERENCES:</strong></p> <ul> <li>Provider contracting experience highly preferred.</li> <li>Understanding of Facets configuration highly preferred.</li> </ul> <p><em>All applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex,&nbsp;national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.</em></p>