Manager Analytics Managed Care

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.

This is a remote position. 

The Manager, Payer Analytics and 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.

• 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 (PIC and SQL) 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.

#LI-CSH

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 contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and/or healthcare operations.
• Minimum of two (2) years of experience in a supervisory role
• Managed Care experience strongly preferred.

Minimum Skill and Abilities Required

• 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 SQL, MS Excel, MS Visual Basic, SAS, Trino or other related applications.
• Intermediate level working knowledge of SQL and Excel.
• 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.
• Ability to effectively lead teams through influence.