Dignity Health, one of the nation's largest health care systems, is a 21-state network of 9,000 physicians, 59,000 employees, and more than 400 care centers, including hospitals, urgent and occupational care, imaging centers, home health, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high-quality, and affordable patient-centered care with special attention to the poor and underserved.
In FY15, Dignity Health provided $1.7 billion charitable care and services. For more information, please visit our website at www.dignityhealth.org. You can also follow us on Twitter and Facebook.
Location - Midwest/Fargo ND
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:
1. Manage the labor and operations of the Payer Analytics & Economics team including the hiring, orienting, developing and managing of staff.2. 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.3. 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.5. 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.6. Act as a liaison between CHI and payer to update information and communicate changes related to reimbursement.7. 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.8. 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. 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.9. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities.10. 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:
1. Manage staff to effectively provide routine reports and ad-hoc analyses as directed, with ability to accuratelyreflect actual performance trends.2.
Manage adverse and politically difficult situations, as the work may have a direct impact the financial performance of CommonSpirit Health.3. Other duties as assigned by management.
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
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
5+ years Healthcare, insurance or related industry experience preferred.
Managed care knowledge preferred.