CareSource
Manager, Vendor Economics
CareSource, Dayton, Ohio, United States, 45402
Job Summary:The Manager, Vendor Economics serves as the leader, subject matter expert, teacher, and mentor of the Vendor Economics team, which is responsible for the end-to-end financial and performance-related analytics for Alternative Payment Models (APM) contracts with vendors or provider groups.
Essential Functions:Assess the financial opportunity associated with implementing new vendors or renegotiating current vendor contractsLead the contractual financial model development, including but not limited to the development of financial targets and reimbursement methodologiesDevelop and apply normalization methods used to establish and/or measure contract performance; to include member acuity, utilization trend, unit cost trend, service case mix adjustment, risk adjustment, Winsorization and other outlier management techniquesLead and participate in development of automation reporting processes which include database development and report developmentSupport Accounting, Disbursement Services, and Actuary by supplying performance forecasts, cost accruals, and invoice submission and validationLead and participate in efforts to identify, quantify and prioritize opportunities to reduce medical costEnsure the timely and accurate measurement outcomes related to medical cost reduction initiativesBuild and maintain collaborative and productive relationships with internal and external stakeholdersPerform any other job-related instructions as requested
Education and Experience:Bachelor's Degree in Mathematics, Economics, Business, Healthcare or related field or equivalent years of relevant work experience is requiredMinimum of five (5) years of experience with healthcare analytics required (health plan preferred)Minimum of three (3) years of experience in leading analytic teams or equivalent
Competencies, Knowledge and Skills:Proficient in MS Excel, PowerPoint and WordProficient in SAS or SQLProficient in financial modelingExceptional problem solving and critical thinking skillsAbility to lead in a hands-on capacityAbility to work collaboratively with all levels of managementAbility to lead mission-critical, highly visible projectsAbility to manage multiple priorities within a dynamic environmentMature written and verbal communications skillsKnowledge of managed care operations and financeExtensive knowledge of fee for service and value based provider reimbursement methodsKnowledge of government healthcare programs (Medicaid, Medicare Advantage required/Marketplace, BPCIA, and MSSP ACO preferred)Knowledge of healthcare quality programs and measures (e.g. CMS, HEDIS, NCQA, AHRQ)Extensive knowledge of health care coding and billing including CPT-4, HCPCS, ICD-9/10, DRG, Revenue Codes and NDC)Knowledge of and ability to utilize various risk adjustment techniques (e.g. CDPS, CMS-HCC, HHS-HCC, ACG)
Licensure and Certification:None
Working Conditions:General office environment; may be required to sit or stand for extended periods of time
#alternativepaymentmodel#APM#valuebased#VBA#MedicalEconomics#ActuarialCompensation Range:$90,500.00 - $158,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.Compensation Type:SalaryCompetencies:- Create an Inclusive Environment- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Essential Functions:Assess the financial opportunity associated with implementing new vendors or renegotiating current vendor contractsLead the contractual financial model development, including but not limited to the development of financial targets and reimbursement methodologiesDevelop and apply normalization methods used to establish and/or measure contract performance; to include member acuity, utilization trend, unit cost trend, service case mix adjustment, risk adjustment, Winsorization and other outlier management techniquesLead and participate in development of automation reporting processes which include database development and report developmentSupport Accounting, Disbursement Services, and Actuary by supplying performance forecasts, cost accruals, and invoice submission and validationLead and participate in efforts to identify, quantify and prioritize opportunities to reduce medical costEnsure the timely and accurate measurement outcomes related to medical cost reduction initiativesBuild and maintain collaborative and productive relationships with internal and external stakeholdersPerform any other job-related instructions as requested
Education and Experience:Bachelor's Degree in Mathematics, Economics, Business, Healthcare or related field or equivalent years of relevant work experience is requiredMinimum of five (5) years of experience with healthcare analytics required (health plan preferred)Minimum of three (3) years of experience in leading analytic teams or equivalent
Competencies, Knowledge and Skills:Proficient in MS Excel, PowerPoint and WordProficient in SAS or SQLProficient in financial modelingExceptional problem solving and critical thinking skillsAbility to lead in a hands-on capacityAbility to work collaboratively with all levels of managementAbility to lead mission-critical, highly visible projectsAbility to manage multiple priorities within a dynamic environmentMature written and verbal communications skillsKnowledge of managed care operations and financeExtensive knowledge of fee for service and value based provider reimbursement methodsKnowledge of government healthcare programs (Medicaid, Medicare Advantage required/Marketplace, BPCIA, and MSSP ACO preferred)Knowledge of healthcare quality programs and measures (e.g. CMS, HEDIS, NCQA, AHRQ)Extensive knowledge of health care coding and billing including CPT-4, HCPCS, ICD-9/10, DRG, Revenue Codes and NDC)Knowledge of and ability to utilize various risk adjustment techniques (e.g. CDPS, CMS-HCC, HHS-HCC, ACG)
Licensure and Certification:None
Working Conditions:General office environment; may be required to sit or stand for extended periods of time
#alternativepaymentmodel#APM#valuebased#VBA#MedicalEconomics#ActuarialCompensation Range:$90,500.00 - $158,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.Compensation Type:SalaryCompetencies:- Create an Inclusive Environment- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.