Manager Analytics Managed Care
2 months ago
Overview
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities
This is a remote position.
Job Summary/Purpose:
The Manager Payer Analytics & Economics is accountable for the managed care financial analysis strategic pricing and payer contract modeling activities for a defined payer portfolio. Oversees and provides analytical and pricing expertise for the evaluation negotiation implementation and maintenance of managed care contracts between CommonSpirit Health providers and payers. Recommends and acts on strategies for maximizing reimbursement and market share. Develops new managed care products with external payers that are consistent with CHI's strategic plans. Provides education to key stakeholders. Leads special projects for the senior leadership as requested.
This position will serve and support all stakeholders through ongoing educational and problem-solving support for managed care payer reimbursement models. This position requires daily contact with senior management physicians hospital staff and managed care/payer strategy leaders. The position must handle adverse and politically difficult situations as the work may have a direct impact on individual physician incomes along with directly impacting the financial performance of CommonSpirit Health. This role must take accountability for designated reimbursement and accounting systems and must be proficient in reading interpreting and formulating complex computer system programming/rules.
Essential Key Job Responsibilities:
- Manage the labor and operations of the Payer Analytics & Economics team including the hiring orienting developing and managing of staff.
- Lead strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language between physicians/hospitals and payers/networks for managed care contracting initiatives. Develop and approve financial models and payer performance analysis.
- Assure satisfactory contract financial performance. Analyze and publish managed care performance statements and determine profitability. Drive strategies and solutions in order to maximize reimbursement and market share which have multi-million or multi-billion dollar impact to CommonSpirit Health. Review and accurately interpret contract terms including development of policies and procedures in support of contract performance.
4.Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations including expected and actual revenues/volumes past performance proposed contract language and regulatory changes.
- Analyze terms of new and existing risk and non-risk contracts and/or amendments/modifications using approved model contract language and following established negotiation procedures.
- Act as a liaison between CHI and payer to update information and communicate changes related to reimbursement.
- Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies approaches provisions parameters and rate structures aimed at establishing appropriate reimbursement levels.
- Identify collect and manipulate from a wide variety of financial and clinical internal data bases (e.g. PIC StarTSI PCON Epic) and external sources (e.g.; Medicare/Medicaid/Payer websites). Identify and access appropriate data resources to support analyses and recommendations. Identify risk/exposure associated with various reimbursement structure options. Gather date and produces analytical statistical reports on new ventures products services on operating and underlying assumptions such as modifications of charge rates.
- Prepare and effectively present results to senior leadership and other key stakeholders for review and decision making activities.
- Maintain knowledge of operations sufficient to identify causative factors deviations allowances that may affect reporting findings. Ability to translate operational knowledge to identify unusual circumstances trends or activity and project the related impact on a timely pre-emptive basis.
Non-Essential Job Responsibilities:
- Manage staff to effectively provide routine reports and ad-hoc analyses as directed with ability to accuratelyreflect actual performance trends.
- Manage adverse and politically difficult situations as the work may have a direct impact the financial performance of CommonSpirit Health.
- Other duties as assigned by management.
Qualifications
Minimum Qualifications:
- Education-
- Sys/Div/Mkt/Local Manager – Bachelor's Degree and minimum of 3 years leadership experience OR minimum of 5 years leadership experience in the discipline OR Master's Degree and no experience
- Bachelor's Degree in Business Administration Accounting Finance Healthcare or related field required or equivalent experience
- Experience -
- Strong background in financial healthcare reimbursement analysis is required including an understanding of national standards for fee-for-service and valuebased provider reimbursement methodologies.
- Five or more years of experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis trend management budgeting forecasting strategic planning and healthcare operations.
- High level of technical understanding and proficiency in SQL Oracle MSAccess MS Visual Basic C++ SAS MS Excel or other related applications.
- Knowledge Skills and Abilities-
- Intermediate level working knowledge of SQL and Excel.
- Intermediate knowledge of fee-for-service and value-based reimbursement methodologies.
- Must be able to lead and coordinate analysis projects through various complex and challenging situations to completion under time-sensitive deadlines.
- Must have working knowledge of healthcare financial statements and accounting principles.
- Ability to use and create data reports from health information systems databases or national payer websites (Epic EPSI PIC SQL Databases etc.).
- Proficiency in reading interpreting and formulating computer and mathematical rules/formulas
Preferred Qualifications:
- 5+ years Healthcare insurance or related industry experience preferred.
- Managed care knowledge preferred.
Pay Range
$ $71.34 /hour
We are an equal opportunity/affirmative action employer.
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