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Senior Pricing Analyst

Mass General Brigham (Enterprise Services)
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Jan 01, 2025
About Us: As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research. We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step. Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration. The Opportunity Mass General Brigham's Revenue Integrity (RI) Department provides MGB entities top-notch revenue cycle expertise and exceptional customer service, while maintaining the integrity of the charge capture process to promote revenue stability in a dynamic healthcare environment. Working as part of a cross-functional team, this position utilizes a strong working knowledge of the Charge Description Master (CDM) and payer reimbursement methodologies to support CDM maintenance, CDM strategic pricing, and price transparency. This position is also responsible for revenue analytics, preparation of Revenue Integrity dashboards, and calculating the financial impact of Revenue Integrity initiatives. Due to its service focus, this position requires strong interpersonal and communication skills, the desire and ability to collaborate with others, superb analytic and organizational skills, and the ability to meet deadlines Principal Duties Responsible for strategic pricing analysis, including calculating the gross and net revenue impact associated with price changes and conducting what-if scenarios to evaluate various pricing models. Develop and maintain CDM pricing models and analytics that incorporate enterprise strategies and relevant data points (including market differentiation, competitive market prices, cost, payment, quality information, etc.). Provide senior level analytic support for the development of hospital CDM fee schedules by assessing and recommending pricing. Evaluation of the impact on budgets related to pricing recommendations and implementation. Key contributor to the development of presentation materials to lay out the context of issues under discussion, analytic findings, options, and recommendations, such that leadership is well informed and able to make decisions. Actively review the CDM for accuracy and make adjustments as necessary. Serve as administrator for the CDM software, including maintaining users, reporting, and performing data reconciliation. Develop and maintain dashboards that track the financial impact of Revenue Integrity initiatives. Prepare revenue analytics to identify fluctuations in revenue and collaborate with Revenue Integrity team members, clinical departments, and other key stakeholders to investigate variances. Perform ad-hoc reporting and data analysis for members of the team as needed. Collaborate with key stakeholders across the enterprise to execute revenue management initiatives. Develop, maintain and implement Revenue Integrity and CDM Management policies, procedures and training materials. Analyze EPIC work queue data for pricing related issues and perform root cause analysis. Execute work plans to correct identified deficiencies. Other duties as assigned. Qualifications Bachelor's degree in accounting, finance, business administration, health administration, or equivalent required. Minimum 7 years of experience in a hospital setting or within the healthcare industry strongly preferred. Knowledge of third party insurance, Medicare billing regulations, CPT/HCPCS, revenue codes, modifiers, billing regulations, and APCs. Epic experience is preferred Skills for Success Intermediate to advanced analytics skills. Proficient at turning data into actionable information in an accurate, reliable and timely manner. Skills include ability to develop well thought out analyses that address the project objective and are easily manipulated to keep pace as the work evolves, proactive questioning and investigation of anomalous results, and consideration of alternative solutions or various analytical paths. Intermediate to advanced technical skills. Ability to navigate various systems, pull and aggregate data using sophisticated software functionality, including but not limited to manipulation of large data sets, database management, querying and financial modeling. Developing ability to think strategically and critically, i.e., ability to develop well-reasoned conclusions, test against relevant criteria/standards and assess in context of the environment and organizational priorities. Organized with solid project managements skills; able to manage multiple projects and deadlines. Effectively use various tools to initiate a project, monitor progress, anticipate obstacles and provide concise updates in a timely manner. Excellent customer service skills; demonstrates an understanding of customers' needs, provides accurate and reliable information to constituents and maintains professional relationships with key contacts. Ability to work independently in a complex, sometimes fast-paced environment. A self-motivated and resourceful attitude, taking intellectual ownership of one's work and the projects under one's scope of responsibility. Proactive in identifying issues, prepared to address concerns/questions, makes recommendations. Proficient with Epic. Ability and willingness to seek out and embrace change. EEO Statement Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment. Additional Job Description Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.