Financial and Regulatory Analyst

Core Functions:

• Payer Policy & Regulatory Intelligence
• Monitor and interpret payer policy updates, government reimbursement rules (e.g., Medicare, Medicaid, commercial plans), and legislation impacting financial performance.
• Analyze changes in payer coverage determinations, billing guidelines, and authorization policies to assess impact on access, documentation, and reimbursement.
• Collaborate with internal stakeholders to implement payer policy changes and ensure compliance across the revenue cycle and clinical departments.
• Identify opportunities for revenue enhancement and cost reduction through proactive management of payer policies.
• Financial Analysis & Forecasting
• Build and maintain financial models to forecast the revenue impact of regulatory or payer policy changes.
• Analyze variances in net revenue, denials, and reimbursement trends related to policy shifts and provide regular reports to the HealthCare Affordability Committee.
• Support budget planning and value-based contract modeling by incorporating regulatory and policy data.
• Develop metrics to track policy compliance, identify gaps, and propose solutions to improve processes and outcomes.
• Document and communicate findings, recommendations, and action plans to the HealthCare Affordability Committee.
• Regulatory Compliance & Reporting
• Track regulatory requirements from CMS, state Medicaid agencies, and commercial payers.
• Collaborate with compliance teams and revenue integrity teams to implement and maintain internal controls and audits to minimize risk.
• Collaborate with payer relations to address any payer-policy-related issues.
• Monitor adherence to payer policies across the organization.
• Partner with clinical and operational teams to ensure policy changes are implemented efficiently and effectively.
• Collaborate with the legal department to review and interpret contracts, agreements, and regulations.
• Communicate effectively with payers to clarify policy details and resolve disputes.
• Work closely with the revenue cycle management team to optimize claims processing and reimbursement.
• Cross-Functional Collaboration
• Act as a liaison between Finance, Compliance, Managed Care, Revenue Cycle, and Clinical Operations teams.
• Analyze clinical vendor reimbursement assumptions.
• Deliver policy summaries and financial impact briefs to operational leaders, with clear recommendations.
• Support stakeholders on new or updated payer policies and regulatory requirements. CentraCare has made a commitment to diversity in its workforce and all individuals, including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.

Core Functions:

• Payer Policy & Regulatory Intelligence
• Monitor and interpret payer policy updates, government reimbursement rules (e.g., Medicare, Medicaid, commercial plans), and legislation impacting financial performance.
• Analyze changes in payer coverage determinations, billing guidelines, and authorization policies to assess impact on access, documentation, and reimbursement.
• Collaborate with internal stakeholders to implement payer policy changes and ensure compliance across the revenue cycle and clinical departments.
• Identify opportunities for revenue enhancement and cost reduction through proactive management of payer policies.
• Financial Analysis & Forecasting
• Build and maintain financial models to forecast the revenue impact of regulatory or payer policy changes.
• Analyze variances in net revenue, denials, and reimbursement trends related to policy shifts and provide regular reports to the HealthCare Affordability Committee.
• Support budget planning and value-based contract modeling by incorporating regulatory and policy data.
• Develop metrics to track policy compliance, identify gaps, and propose solutions to improve processes and outcomes.
• Document and communicate findings, recommendations, and action plans to the HealthCare Affordability Committee.
• Regulatory Compliance & Reporting
• Track regulatory requirements from CMS, state Medicaid agencies, and commercial payers.
• Collaborate with compliance teams and revenue integrity teams to implement and maintain internal controls and audits to minimize risk.
• Collaborate with payer relations to address any payer-policy-related issues.
• Monitor adherence to payer policies across the organization.
• Partner with clinical and operational teams to ensure policy changes are implemented efficiently and effectively.
• Collaborate with the legal department to review and interpret contracts, agreements, and regulations.
• Communicate effectively with payers to clarify policy details and resolve disputes.
• Work closely with the revenue cycle management team to optimize claims processing and reimbursement.
• Cross-Functional Collaboration
• Act as a liaison between Finance, Compliance, Managed Care, Revenue Cycle, and Clinical Operations teams.
• Analyze clinical vendor reimbursement assumptions.
• Deliver policy summaries and financial impact briefs to operational leaders, with clear recommendations.
• Support stakeholders on new or updated payer policies and regulatory requirements. CentraCare has made a commitment to diversity in its workforce and all individuals, including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.