Senior Business Intelligence Developer (Managed Care Contracting)

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 of diverse individuals 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 recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and where your diversity of culture, thinking, learning, and leading is 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:

Finance-Dashbrd/Rprting/Anlytc

Job Summary:

JOB SUMMARY

Develops and modifies Business Intelligence solutions independently for finance-related content, including Managed Care Contracting, Revenue Cycle, and Compliance. Designs data models used for reporting and analytics, develops ETL processes for data, and utilizes BI tools to satisfy end user data needs. Creates and manages BI and analytics solutions, transforming data into valuable insights for our Managed Care Contracting, Revenue Cycle, and Finance teams. Implements large/multiple development projects. Functions as lead on projects. Additional responsibilities include reviewing current managed care contracts, validating contract compliance, and addressing changes impacting these contracts.

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JOB SUMMARY

Develops and modifies Business Intelligence solutions independently for finance-related content, including Managed Care Contracting, Revenue Cycle, and Compliance. Designs data models used for reporting and analytics, develops ETL processes for data, and utilizes BI tools to satisfy end user data needs. Creates and manages BI and analytics solutions, transforming data into valuable insights for our Managed Care Contracting, Revenue Cycle, and Finance teams. Implements large/multiple development projects. Functions as lead on projects. Additional responsibilities include reviewing current managed care contracts, validating contract compliance, and addressing changes impacting these contracts.

KEY RESPONSIBILITIES

Data Analysis: Organize and review financial and utilization data, including insurer claims, hospital and physician billing data, and payer fee schedules.

Support: Assist other departments with financial management and evaluation of hospital contracts, support contract negotiation processes, and prepare financial performance models.

Contract Management: Review and understand all managed care contracts, provide analytical support, model payer rate proposals, and recommend strategies to maximize reimbursement.

Reporting: Utilize EPSi and Epic Clarity reporting capabilities to create managed care reports and generate profit and loss reports on individual contracts.

Compliance: Audit payor contracts in EPIC patient billing system to ensure terms are loaded consistently with agreements.

Data Security: Ensures integrity and security of institutional data

TECHNICAL CAPABILITIES

• Demonstrates skilled use of SQL, Python, Databricks and Epic Clarity data to develop payer specific technical contract models in a Databricks Data Warehousing environment.
• Delivers Business Intelligence models in Tableau.
• Expert Excel Skills
• Proficient use of Microsoft Office Products

CORE ACCOUNTABILITIES

• Independently develops, maintains and uses contract models to deliver financial impact and insight to the contracting team in support of all phases of the contracting life cycle. 
• Ability to understand and analyze complex contracting finance models and present the results in simple terms. 
• Uses multiple sources of data to present new perspectives that result in creative solutions.
• Has advanced knowledge of medical finance and provider / payer payment systems.
• Service as an expert resource to contracting and finance teams.
• May lead small project teams.
   

CORE CAPABILITIES

• Uses effective verbal and written communication to convey complex ideas and information that influence key stakeholders.

• Skilled in collaboration with diverse teams in a way that fosters cooperation and achieves collective goals.
• Readily adapts to new situations. Learns quickly and navigates change effectively.
• Delivers Quality Work.  Attention to detail.  Uses checklists and checking techniques to verify results are accurate.  Documents the analysis and methodologies used in a clear manner such that another analyst could duplicate the work.
• Generates New Ideas: Proactively identifies opportunities for improvement and works to implement continuous improvement.

Experience Level: 5 years

Education: Bachelor’s (Required)
 

Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled

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 (Required)

Vanderbilt Health recognizes that diversity is essential for excellence and innovation. We are committed to an inclusive environment where everyone has the chance to thrive and to the principles of equal opportunity and affirmative action. EOE/AA/Women/Minority/Vets/Disabled