System Manager Payment Transformation - Remote Opportunity
CommonSpirit Health was formed in 2019 by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 1,000 care sites across 21 states, CommonSpirit services are accessible to nearly one out of every four U.S. residents. We are committed to building healthy communities and innovating how and where healing can happen, both inside our hospitals and out in the community. We believe our health shouldn’t depend on our zip code, economic status, or the color of our skin. If you are committed to social justice and health equity–and prepared to deliver care in new, innovative ways, you belong with us.
This position directly links to our Mission of improving the health of the people we serve by providing financial pricing performance and analytics in support of value-based agreements and payment transformation initiatives. This position develops, recommends and assists with implementing strategies for maximizing reimbursement and market share from value-based programs and payment models, including initiatives sponsored by CMS and the CMS Innovation Center. The Manager, Payment Transformation develops data analytics in support of new value-based initiatives with payers that are consistent with established strategic priorities.
The successful candidate will serve and support all stakeholders through ongoing educational and problem-solving support for VBA payer reimbursement models. This position requires daily contact with senior management, physicians, population health operations staff, and managed care/payer strategy leaders. Salary for this remote position is dependent upon skills, qualifications, experience, and geographic location. This remote position may require occasional travel to the Denver, CO system office.
- Manage the labor and operations of the Payment Transformation team including the hiring, orienting, developing and managing of staff.
- Prepare and effectively present VBA analysis results to senior leadership and other key stakeholders, for review and decision-making.
- Act as the Payer Strategy & Relationship (PSR) leader liaison for all dashboards, funds flow models, and other analytics that support CommonSpirit Health’s successful participation in CMS/CMS Innovation Center-sponsored value-based initiatives, including the Medicare Shared Savings Program (MSSP), the Next Generation ACO Model, and bundled payment programs such as Bundled Payments for Care Improvement Advanced (BPCI-A).
- Lead strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement rates and associated language, between physicians/hospitals and payers/networks for value-based payer contracting initiatives. Develop and approve financial models for value-based agreements (VBAs) using SQL and Excel.
- Assure satisfactory VBA contract financial performance. Analyze and publish VBA performance statements and determine profitability. Drive strategies and solutions in order to maximize VBA reimbursement and market share, which have multi-million or multi-billion-dollar impact to CommonSpirit Health. Review and accurately interpret VBA contract terms, including development of policies and procedures in support of value-based arrangement negotiations.
- Provide training and oversight of the modeling of proposed/existing VBAs negotiated by Payer Strategy and Relationships, including expected and actual revenues/volumes, population risk calculations, past performance, proposed contract language and regulatory changes.
- Analyze terms of new and existing risk and non-risk VBAs and/or amendments/modifications using approved model contract language and following established negotiation procedures.
- Maintain knowledge of operations sufficient to identify causative factors that may affect reporting findings. Ability to translate operational knowledge to identify unusual circumstances, trends, activity and projections of the related impact on a timely, preemptive basis.
- Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare Administration or related field required. Master’s Degree preferred.
- Minimum of five (5) years’ experience in healthcare finance or analytics, including an intermediate to advanced level knowledge of value-based provider reimbursement methodologies, including capitation, shared risk/shared savings, and bundled payments.
- Minimum of three (3) years leadership experience.
- Advanced level knowledge of SQL and Excel.
- Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas.
- Experience creating analytic dashboards with Qlik, PowerBI, and/or Tableau a plus.
- Working knowledge of healthcare financial statements and accounting principles.
Compensation: A compensation range of $102,000 - $148,000 is a reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law. As a remote employee, we will provide you with the equipment needed to work from home including a laptop, docking station, dual monitors, and accessories. We also reimburse you for monthly internet and phone expenses.
Benefits: While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that include Medical, Dental, Vision, paid vacation, matching retirement plans, life insurance plans, tuition assistance, adoption assistance, a robust Employee Assistance Program (EAP), annual bonus eligibility and more!
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