Dignity Health is one of the nation's largest health care systems. As of June 30, 2017, Dignity Health operated more than 400 care centers, including hospitals, urgent and occupational care, imaging and surgery centers, home health, and primary care clinics in 22 states, through its network of more than 9,000 physicians and more than 60,000 employees. Headquartered in San Francisco, CA, Dignity Health is dedicated to providing compassionate, high-quality, and affordable patient-centered care with special attention to those who are poor and underserved. In its fiscal year ended June 30, 2017, Dignity Health provided $2.6 billion in charitable care and services. More information on Dignity Health is available at www.dignityhealth.org.
This position is responsible for providing analytical support for the Managed Care department that involves synthesizing data from multiple sources into clear, meaningful negotiation and decision making tools. Responsibilities include developing a local managed care utilization database, producing contract performance reports, modeling reimbursement rates, evaluating and quantifying financial contract modifications and compiling and monitoring key managed care statistics. The incumbent will serve as a managed care resource for internal departments (i.e. patient financial services and decision support).
Access, extract, analyze and maintain utilization data from various managed care information systems for the purposes of modeling and reporting financial statistics to drive managed care strategy and decision making
Model contract reimbursement terms to determine expected financial impact of contract modifications and charge master effects, with a high degree of accuracy and speed.
Develop and generate reporting templates for monitoring managed care contract performance (both capitation and FFS) including, but not limited to: P&L statements, comparisons of expected yield to actual yield, and comparison of actual yield to cost.
Evaluate and respond to data/statistical reporting requests from hospitals, division and system offices; work closely with Manager, Managed Care Analytics to coordinate local market efforts in support of statewide payer negotiations.
Create, establish and ensure maintenance of ongoing tracking and reporting systems and methodologies in order to measure and document results of contract negotiations.
Monitor and ensure that sound financial modeling practices are utilized and tools developed by the Managed Care Department are consistently applied to accurately calculate Dignity Health's managed care expected revenues.
A minimum of 5 years experience in a healthcare financial setting (provider or health plan-based) with progressive responsibility or comparable combination of education and experience (required).
Bachelors degree with an emphasis in healthcare, finance or a related field (required).
Training in and/or advanced working knowledge of Microsoft Excel, Access and WORD or equivalents programs (required).
Special Skills -
Special skills required include: Healthcare reimbursement methodologies Healthcare coding methodologies (DRG, APC, RBRVS, ICD-9 and HCPCS) Proficient in database management Healthcare industry trends Financial analysis techniques Effective management and communication