Remote Commercial Insurance Jobs in Springfield, TN

Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community ofindividuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniquenessis sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt's mission is to advance health and wellness through preeminent programs in patient care, education, and research.

Organization:

Underpayments

Job Summary:

JOB SUMMARY
oUnder the strategic direction of the Manager of Payer Analytics, the Senior Analyst of Payer Analytics will drive payer contracting strategy by performing in-depth contract analytic design, execution, and interpretation. This involves deep dive analytics into payer performance and proposed contract terms to order to make decisions on how to structure payer contracts. This position will participate in the design and interpretation of standard reporting as well as conducting ad-hoc drilldowns for specific business issues. There will be interaction with CEOs and executives across three hospital sites as well as revenue cycle, payer relations, and other leadership teams.

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• Job Responsibilities
  • 20%| Strategy and Insights: Work with payer relations team on analytic design, execution, and interpretation. Deliver and present analytics and interpretation to business leaders in a digestible format. Provide perspective on new analytics to support payer reimbursement and performance. Proactively take steps towards automation or use of new technology. Provide thoughtful perspective in meetings with management. Understand Medicare and commercial reimbursement, policies, and regulatory requirements and apply to contract modeling, insights, and new ideas. Manage customer expectations and relationships and maintain alignment of deliverables with organization analytic needs. Serve as an expert on payer contract financial terms and financial modeling. Design and interpret analytics, lead training, and respond to questions across multiple departments.
  • 50%| Contract Maintenance: Load, update, and maintain contracts in collaboration with a vendor. Develop and maintain workflows and management processes to ensure there are no errors in contract modeling or loading. Model the effect of fee schedule updates on revenue and percentage of Medicare. Identify, interpret, and make recommendations regarding unclear contract or proposed contract terms.
  • 30%| Analytic Support: For both payer contract negotiations and monitoring, discuss business needs with customer and influence the design of an analysis and execute based on jointly designed specifications. Analyze data to work with colleagues to generate business insights and roll up data into a digestible format. Ability to use data extract and BI tools such as SQL and Tableau/PowerBI. Work with manager to efficiently merge data from multiple databases and find efficient ways to complete reporting.

• Skills, Education and Additional Information
  • • Minimum of bachelor's degree in Business, Healthcare, Computer Science or related field.
    • Master's degree in Business Administration or comparable field of study preferred.
    • 3 or more years' experience in a managed care/healthcare environment with exposure to contract management and program development
    • EPIC experience
    • EPIC Hospital and Professional contract certification
    • Technical ability in ETL and visualization tools such as Tableau, PowerBI, and SQL
    • Knowledge of claims processing systems and guidelines Experience with reimbursement methodologies for Medicare and commercial insurance; and regulatory requirements concerning payer contracts
    • Ability to produce analytics that are well-documented and easy to follow
    • Analytical skills with the ability to collect, organize, analyze, and disseminate information with attention to detail and accuracy
    • Strong written and verbal presentation skills including the ability to translate information to a variety of audiences
    • Ability to build strong relationships with internal and external stakeholders
    • Ability to be flexible and adapt in order to achieve initiative and organizational goals

Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more.

At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose.

Core Accountabilities:

Organizational Impact: Independently delivers on objectives with understanding of how they impact the results of own area/team and other related teams. Problem Solving/ Complexity of work: Utilizes multiple sources of data to analyze and resolve complex problems; may take a new perspective on existing solution. Breadth of Knowledge: Has advanced knowledge within a professional area and basic knowledge across related areas. Team Interaction: Acts as a "go-to" resource for colleagues with less experience; may lead small project teams.

Core Capabilities :

Supporting Colleagues: - Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas. - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships. - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Services: - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them. - Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions. - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly. - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure. - Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area. - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation: - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches. - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges. - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.

Position Qualifications:

Responsibilities:

Certifications:

Work Experience:

Relevant Work Experience

Experience Level:

5 years

Education:

Bachelor's

This role offers the opportunity to make a meaningful impact within Vanderbilt Health, supported by a comprehensive benefits package which mayinclude health, disability, retirement and/or wellness offerings to enhance your well-being and professional growth.

Vanderbilt Health is committed tofosteringan environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.