BWPO Sr. Revenue Analyst

Affiliate Name: Brigham & Women's Physicians Organization
Job Category: Financial/Accounting/Billing
Department: BWPO FINANCE
Shift: Days
Hours/Week: 40
Job Type: Regular
Employment Type: Full TimeResponsibilities:
Responsibilities:The Senior Revenue Analyst is primary responsible for independently overseeing and maintaining the BWPO contract management and revenue modeling program (Preferred Medical Marketing Corporation (PMMC)), including but not limited to, the following:o Provide and confirm all relevant contract information and updates are current; including third-party payer rules, logic changes, fee schedules rates, and associated payer data.
o Monitor and evaluate the financial performance of third-party contracts to identify, audit and resolve variances between amounts paid on claims and agreed-upon fee schedules rates.
o Analyze payer bundling rules and develop logic to clarify payment logic in the PMMC database.
o Verify and maintain data integrity of various source systems feeds/interfaces and reports (IDX interface, PMMC database, Physician On-line Reporting (POLR).
o Work with various departments to establish resolution workflows and documentation for identifying third party payment variances and root causes of discrepancies. Departments include: Financial Services, Managed Care Contracting, Physician Payer Relations, Physician Payment Analysis Team (PPAT), and Decision System Support.
o Develop a mechanism for communication of relevant payment trends and variances to responsible parties for follow-up and closure of open issues on a timely basis.
o Work with the Decision Support Team to design contract management reports that allow end users to identify transactions and invoices variances from expected contractual and expected payment levels.
o Develop and maintain documentation for contract management reports, as well as developing an expertise in data availability, quality, meaning and interpretation, which is needed to train report users.
o Coordinate efforts of Physician Payment Analysis Team to use PMMC simulator PRO application for Partners HealthCare System, Inc fee schedule modeling.
o Assist the Physician Payment Analysis Team to develop comprehensive reimbursement models to assess the financial impact of various reimbursement rates for prospective contracts.Other responsibilities include BWPO fee schedule and contract analysis, managing funds flow, and benchmarking, including but not limited to, the following:o Coordinate with Physician Payment Analysis Team to ensure quality of work and contract analysis priorities are met related to the creation of the Partners HealthCare System, Inc wide Joint Chargemaster Schedule.
o Analyze and distribute the impact of the new fees for all BWPO departments that are used for the annual budget process, as well as addressing questions and concerns accordingly.
o Serve as liaison representative between the PPAT and BWPO clinical departments to address questions and concerns related the impacts of new fees for all BWPO departments.
o Lead analytics for settlement related to BWPO payer contract disputes.
o Research and conduct impact analysis on issues regarding policy changes to Medicare, Medicaid and other payer reimbursement, including updates to the work relative value units (RVUs) and practice expense RVUs, by Specialty and its impact on physician fee schedule and physician incentive compensation plans.
o Participant in physician productivity and compensation benchmarking analysis, modeling, reporting and surveys.
o Review and distribute payer supplemental funds to various BWPO clinical departments based on distribution models prepared by Physician Payment Analysis Team.
o Manage the Private Staff Association's (PSA) funds flow of payer supplemental, pay-for-performance withholds and PSA annual membership fees.
o Lead analytics for PSA interim and final settlement.
o Perform other ah hoc analysis and reporting support for senior management, as needed.
o Perform supervisory duties for analytic support as necessary.
REQUIREMENTS
Requirements:
Education: Minimum of Bachelor's degree. Masters degree in related field preferred.
Experience:
o At least three to five years of progressively responsible relevant experience, including demonstrated ability to manage multiple responsibilities in complex environment.
o Demonstrate proficiency with spreadsheets, database, and presentation software is required
o Comprehensive understanding of healthcare/payer environment.
o Working knowledge of hospital and physician reimbursement and chargemaster development is required.
o Understanding of RBRVS payment methodology along with other physician payment systems.
o Solid experience with clinical and financial systems; and advance knowledge of reimbursement principles including Medicare, Medicaid and Managed Care.
o Experience in one or more specific aspects of position highly desirable.Skills and Abilities:
o Excellent interpersonal skills, including the ability to establish and maintain effective relationships with patients, physicians, management staff and other customers.
o Demonstrate customer service skills, including the ability to use appropriate judgment, independent thinking and creativity when resolving customer issues.
o Ability to work independently and as a member of a team.
o Strong written and verbal communication skills.
o Strong organizational, analytic and financial skills.
o Familiarity with IDX billing system for data extraction and analysis.Supervisory Responsibilities: As needed.