Reporting to the Head of Payor Relations, the Pricing Analyst will provide analytical and commercial support in relation to private medical insurers for the provider.
The role will support all ongoing contractual relationships with all private payors. In addition, the Analyst will work with Revenue Cycle Management (RCM) leadership and Clinical leadership to monitor and report the performance of payor agreements.
Our client is an Internation Private Healthcare Provider who has set up a new site in the heart of London.
Pricing and Risk Assessment
- Develops pricing models for payor price negotiations, in collaboration with Finance.
- Proposes pricing strategy to maximize opportunities and minimize risk.
- Assesses and proposes service line and bundled pricing, working with Finance and the Clinical Institutes to achieve revenue and margin, and to assess and record risk.
- Supports Finance and the Clinical Institutes to agree local and international self-pay pricing, including agreed discount options.
- Supports the Head of Payor Relations to ensure that all pricing and terms maximize operational efficiency and margin, and are in line with CCL values, while achieving agreed payor objectives.
- Develops a comprehensive analytic framework to support each payor contract negotiation and to lead an effective negotiation strategy.
- Seeks out opportunities to incorporate measurable outcomes and quality indicators or value-based reporting parameters into the relationships.
- Responsible for day to day operational issues with payor agreements and manages relationships effectively across the contracting life cycle.
- Monitors contract terms and conditions for compliance with financial and operating terms.
- Participates in operational corrective actions for compliance issues.
- Responsible for development of tools and resources to assist clinical and finance caregivers with contract compliance.
- Responsible for developing and implementing audit tools and processes with payors, in liaison with RCM and IT, to ensure contract compliance.
- Bachelor's degree in business, finance or information science preferred, health and safety field knowledge also desirable
- Ability to speak and write in English is required.
- CIMA (qualified) preferred
Complexity of Work:
- Within the scope of the job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
- Must be able to work in a fast paced, fluid environment.
- Demonstrated experience with critical thinking in order to understand the impact of decisions across the organization and how to drive broader solutions.
- Ability to make administrative and procedural decisions and judgments on sensitive, confidential issues.
- Strong familiarity with key contract terms, reimbursement methodologies, legal issues and contract analysis.
- Previous experience and expertise with contract terms, reimbursement methodologies, legal issues and contract analysis.
- Previous experience and expertise using Excel at advanced level (building macros), and SQL databases
- Exposure to developing reporting and analysis tools
- Previous experience of commercial analysis to support commercial negotiations.
- Knowledge of the private healthcare market is highly desirable.
- Pricing Analyst
- Health and Safety
- Competitive salary and benefits