OU Medicine
Director Managed Care Analytics
OU Medicine, Oklahoma City, Oklahoma, United States, 73116
Director Managed Care Analytics
Position Title:
Director Managed Care Analytics Department:
Financial Services Job Description:
Reporting to the SVP, Managed Care, the Director, Managed Care Analytics oversees payer reimbursement modeling and data analytic support to OU Health Managed Care Contracting functions, transforms claims and clinical data into actionable reports, designs and performs contract modeling, and develops contract performance dashboards. The Director also participates in contract negotiations and actively manages financial components of active contracts, evaluating and providing key input into the determination of financial strategy for payer proposals in conjunction with Managed Care leadership to ensure Managed Care goals are supported. Develops and maintains productive relationships with key stakeholders, both internal and external to the organization. Essential Responsibilities: Developing dashboards and ad-hoc reporting with minimal guidance in Excel/Tableau/PowerPoint. Perform complex data analysis and contract modeling support of ad-hoc and standing management or customer requests. Collaborate with cross-functional teams, including clinical, technical, and finance teams. Validate data extracts and analyze any data variances. Conduct service line managed care reimbursement analysis as requested by Management. Work with applicable teams to develop value-based contract measures and metrics. Manage the calculation and implementation of contract escalation language and system impacts. Identify and integrate data from multiple sources and build reimbursement models, dashboards, and reports within various platforms. Develop and perform routine and ad-hoc reporting to evaluate performance and identify opportunities for process improvements. Perform statistical analysis of data extracted from various internal sources and prepare reports based on findings. Proactively identify data trends and outliers and provide suggestions for improvements. Responsible for data and information compilation, design, and analysis; developing clear and concise reports for distribution. Create and maintain business process and technical workflow documents. Act as managed care analytics SME on multi-disciplinary teams. Supervise, coach, and mentor the Manager, Managed Care Analytics. General Responsibilities: Perform other duties as assigned. Minimum Qualifications: Education:
Bachelor’s degree in Business, Finance, Health Care, Economics, or related field is required. MBA, MHA, or related master’s degree preferred. Experience:
5 - 7 years of professional experience within an Academic Medical Center, Multi-hospital Health System, or Managed Care Organization (MCO), with demonstrated experience in healthcare analytics and medical economic modeling. SQL, Tableau, and Strata experience preferred. License(s)/Certification(s)/Registration(s) Required:
Epic Resolute PB and HB certification required or must obtain both within 6 months of hire. Knowledge, Skills, and Abilities: Strong knowledge of hospital and physician reimbursement methodologies. Working knowledge of billing/coding terminology. Procedural knowledge of hospital and physician practice accounts receivable management. SQL subject-matter-expert with experience in data queries. Proficiency with EPIC, Experian, and/or other contract management systems preferred. Financial and analytical skills necessary to interpret complex quantitative information. Detail-oriented, with effective research and problem-solving skills. Strong understanding of healthcare data including cost of care and patient utilization metrics. Knowledge of medical coding and business terminology. Ability to access data using information systems required for analysis and reporting. Proficient with SAS, SQL server database, Microsoft Excel, Microsoft Word, Power BI, Python, and other tools as needed. Demonstrated experience in generating descriptive reports and corresponding analysis. Advanced proficiency in Microsoft Office Suite, particularly MS Excel, Access, and PowerPoint. Strong written and verbal communication skills. Team-oriented with strong communication, interpersonal, and presentation skills. Ability to work with diverse groups of individuals. Self-directed individual with the ability to prioritize work across multiple priorities.
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Position Title:
Director Managed Care Analytics Department:
Financial Services Job Description:
Reporting to the SVP, Managed Care, the Director, Managed Care Analytics oversees payer reimbursement modeling and data analytic support to OU Health Managed Care Contracting functions, transforms claims and clinical data into actionable reports, designs and performs contract modeling, and develops contract performance dashboards. The Director also participates in contract negotiations and actively manages financial components of active contracts, evaluating and providing key input into the determination of financial strategy for payer proposals in conjunction with Managed Care leadership to ensure Managed Care goals are supported. Develops and maintains productive relationships with key stakeholders, both internal and external to the organization. Essential Responsibilities: Developing dashboards and ad-hoc reporting with minimal guidance in Excel/Tableau/PowerPoint. Perform complex data analysis and contract modeling support of ad-hoc and standing management or customer requests. Collaborate with cross-functional teams, including clinical, technical, and finance teams. Validate data extracts and analyze any data variances. Conduct service line managed care reimbursement analysis as requested by Management. Work with applicable teams to develop value-based contract measures and metrics. Manage the calculation and implementation of contract escalation language and system impacts. Identify and integrate data from multiple sources and build reimbursement models, dashboards, and reports within various platforms. Develop and perform routine and ad-hoc reporting to evaluate performance and identify opportunities for process improvements. Perform statistical analysis of data extracted from various internal sources and prepare reports based on findings. Proactively identify data trends and outliers and provide suggestions for improvements. Responsible for data and information compilation, design, and analysis; developing clear and concise reports for distribution. Create and maintain business process and technical workflow documents. Act as managed care analytics SME on multi-disciplinary teams. Supervise, coach, and mentor the Manager, Managed Care Analytics. General Responsibilities: Perform other duties as assigned. Minimum Qualifications: Education:
Bachelor’s degree in Business, Finance, Health Care, Economics, or related field is required. MBA, MHA, or related master’s degree preferred. Experience:
5 - 7 years of professional experience within an Academic Medical Center, Multi-hospital Health System, or Managed Care Organization (MCO), with demonstrated experience in healthcare analytics and medical economic modeling. SQL, Tableau, and Strata experience preferred. License(s)/Certification(s)/Registration(s) Required:
Epic Resolute PB and HB certification required or must obtain both within 6 months of hire. Knowledge, Skills, and Abilities: Strong knowledge of hospital and physician reimbursement methodologies. Working knowledge of billing/coding terminology. Procedural knowledge of hospital and physician practice accounts receivable management. SQL subject-matter-expert with experience in data queries. Proficiency with EPIC, Experian, and/or other contract management systems preferred. Financial and analytical skills necessary to interpret complex quantitative information. Detail-oriented, with effective research and problem-solving skills. Strong understanding of healthcare data including cost of care and patient utilization metrics. Knowledge of medical coding and business terminology. Ability to access data using information systems required for analysis and reporting. Proficient with SAS, SQL server database, Microsoft Excel, Microsoft Word, Power BI, Python, and other tools as needed. Demonstrated experience in generating descriptive reports and corresponding analysis. Advanced proficiency in Microsoft Office Suite, particularly MS Excel, Access, and PowerPoint. Strong written and verbal communication skills. Team-oriented with strong communication, interpersonal, and presentation skills. Ability to work with diverse groups of individuals. Self-directed individual with the ability to prioritize work across multiple priorities.
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