Salary $159,996 - $223,994 a year job type full-time
Full job description
Commonspirit health was formed by the alignment of catholic health initiatives (chi) and dignity healthWith 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.sResidentsOur world needs compassion like never beforeOur communities need caring and our families need protectionWith 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.
The system vice president, payer analytics & economics is accountable for the managed care financial analysis, strategic pricing and payer contract modeling activities for commonspirit health`s payer portfolioOversees and provides analytical and pricing expertise for the evaluation, negotiation, implementation and maintenance of managed care contracts between commonspirit health providers and payersRecommends and acts on strategies to optimize reimbursement and increase market shareDevelops new managed care products with external payers that are consistent with approved strategic plans.
This role is a key member of the commonspirit health leadership team, and will make significant contributions to the development and implementation of system and local strategy, transformation to a clinical enterprise, successful physician alignment strategies, achievement of employee engagement goals, and achieving budgetsThe 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 national payer analytics & economics team(s) 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 performanceAnalyze 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 analysesDevelop 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 levelsPrepare 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 optionsGather 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 findingsAbility to translate operational knowledge to identify unusual circumstances, trends, or activity and project the related impact on a timely, preemptive basis.
Master’s degree required.
Minimum of ten (10) years progressive leadership responsibility and experience in large healthcare organizations and/or integrated healthcare delivery systems.
Minimum of seven (7) years strategic management of healthcare pricing, contract negotiation, and healthcare economics in a complex, national or multi-regional healthcare system or health insurance environment.
Expert knowledge of financial healthcare reimbursement analysis 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 access, ms visual basic, sas, 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 staff at all levels, driving by influence.
Ability to maintain collaborative and effective relationships at all levels and with key stakeholder.
A compensation range of $159,996 - $223,994 is the reasonable estimate that commonspirit in good faith believes it might pay for this particular job based on the circumstances at the time of postingCommonspirit may ultimately pay more or less than the posted range as permitted by law.
While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that include health/dental/vision, fsa, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more!