Manager Payer Analytics Economics id-8735
Responsibilities
This is remote position. Strong preference for candidate to live in Eastern or Central time zone.
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. This position will serve and support all stakeholders through ongoing educational 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.
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ESSENTIAL KEY JOB RESPONSIBILITIES
- Manage the labor and operations of the Payer Analytics & Economics team including the hiring, orienting, developing and managing of staff.
- Oversee quality control and quality assurance of Payer Analytics & Economics analytics deliverables and financial models to support the negotiation and implementation of appropriate reimbursement rates associated
language, between physicians/hospitals and payers/networks for managed care contracting initiatives. - Review and accurately interpret contract terms, including payer policies and procedures to appropriately contract performance and influence strategic pricing strategies.
- Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability.
- 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. - 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. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities.
- Identify, collect, and manipulate from a wide variety of financial and clinical internal data bases (e.g., PIC, STAR, TSI, PCON, EPIC) and external sources (e.g., Medicare/Medicaid/Payer websites). Identify and access appropriate
data resources to support analyses and recommendations. - Assess risk/exposure associated with various reimbursement structure options. Gather data and produces analytical statistical reports on new ventures, products, and services on operating and underlying assumptions such as modifications of charge rates.
- Maintain knowledge of operations sufficient to identify causative factors, 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.
Qualifications
Required Education and Experience
- Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare or related field. Equivalent education and experience in related field(s) may be considered in lieu of degree.
- Minimum of five (5) years of experience in Healthcare Finance contributing to profitability through detailed financial analysis of managed care contracts is required. Experience in trend management, budgeting, forecasting, strategic planning, and/or healthcare operations is preferred.
- Minimum of two (2) years of experience in a lead or supervisory role.
Required Minimum Skills, Abilities & Training
- Strong background in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies.
- High level of technical understanding and proficiency in MS Excel, or other related database applications.
- Intermediate level working knowledge of SQL.
- 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, PIC, SQL, Databases, etc.).
- Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas.
- Ability to effectively lead teams through influence.
- Ability to effectively build and sustain collaborative relationships with all levels of the organization.
Overview
Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2300 clinics care sites and 137 hospital-based locations in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157000 employees 45000 nurses and 25000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care community benefits and unreimbursed government programs. Together with our patients physicians partners and communities we are creating a more just equitable and innovative healthcare delivery system.
