Manager Payor Analytics

Job Description - Manager Payor Analytics (240002E6)DescriptionThe Manager of Payor Analytics is responsible for working collaboratively with the Director of Managed Care and the Reimbursement Officer in the development of analytical tools and resources for managing the negotiations for all payors including commercial contracts and government payments across Children's National Health System. The Manager of Payor Analytics will develop and implement tools to evaluate third party payors to enhance, maintain and strengthen the financial analytical capabilities of the department; will help to provide tools for addressing future state healthcare payment systems, programs and models for the department. The Manager of Payor Analytics will support the preparation of the annual CMS and State Cost Reports and other government documents affecting rate setting and payments. The Manager of Payor Analytics will work with the Director of Managed Care and the Reimbursement Officer to ensure that the appropriate resources and accurate inputs are used with regards to third party payor data for negotiations. The manager will support the functions of the department in internal CNHS's meetings regarding third party payor relationships, contracting, and initiatives. The manager will ensure that appropriate data is used to support the Director of Managed Care during the negotiation of payor contracts. The manager will support payer evaluations and financial analyses to assure contracts meet the objectives of the system. The manager will instruct and supervise the staff in the department on the appropriate use of data for analytics and reporting, with emphasis on the Senior Managed Care Analyst. The manager will support the department leadership with analyses, data, and recommendations for strategic planning for contractual payment models and opportunities. The manager will work on special projects as assigned.QualificationsMinimum EducationBachelor's Degree or Master's degree in Business Administration, Hospital Administration, Public Health Administration, or equivalent experience in a related field required. (Required)Minimum Work Experience10 years of related health care experience with a minimum of 2 years supervisory experience in a related job function.Required Skills/KnowledgeExperience in and knowledge in healthcare payment systemsGeneral knowledge of contract negotiation strategies, tactics and contract languageStrong creative and analytical skills for the development of contract terms, data interpretation, and contract analyticsBasic understanding of current payment market conditions and trendsWritten and verbal communication skillsUnderstanding of a broad range of healthcare financial activities including third party reimbursement, revenue cycle, budgeting, and accountingKnowledge and experience with technology tools in both large systems and with pc based productsKnowledge in Cost Reporting including payment components such as IME/GME, Capital, Bad Debt, Time Studies, etc.Basic knowledge interpreting federal and state payment rules and regulationsFunctional AccountabilitiesTransform Department Vision and Strategy for optimal PerformanceSupport the directors with data for payer strategic direction with contracting and network developmentDevelopment of pricing methodologies in support of new programs or clinical business planning (i.e. value based, bundles, center of excellence, etc.)Assist with the development of a communication tool to ensure the effective communication of payor relations programs and government regulatory changes to CNHS management and staffWork with the contract managers and provide data that expands beyond our traditional service areasWork to continually enhance, improve and assure optimal efficiency of this functionPayer Relations Strategy DevelopmentAssist with the evaluation of the economic impact of conditions, healthcare delivery options, legislations, competitors, state Medicaid agencies and the managed payer environmentWork with directors to ensure the department objectives are metSupport the payor negotiation process for new and existing contract relationships, ensuring data integrity to preserve CNHS’s financial integrityIdentify areas to promote efficiency in the contracting processPayer Relationships and ReportingSupport a positive working relationship with Medicaid Agencies to address operational, contractual, or reimbursement/payment issues on a timely basisDevelop the analytic process that gathers, reviews, analyzes data reflecting payer performance to evaluate managed care relationships and state Medicaid agenciesDevelop analyses of financial and statistical data used in reimbursement reports to determine accuracy, consistency from year to year, and effects upon the institution’s reimbursement or final settlementsManagement of Information TechnologyProvide quality data to support the department’s function of analyzing and reporting on managed care and state Medicaid payer activities, contracting, reimbursement levels, compliance, and performanceActively use administrative and clinical information technology and decision-support tools in processes and performance improvementOrganizational AccountabilitiesPrimary Location

Maryland-Silver SpringWork Locations

Tech Hill12211 Plum Orchard DriveSilver Spring 20904Job

Non-Clinical ProfessionalOrganization

FinancePosition Status: R (Regular) - FT - Full-TimeShift: DayWork Schedule: 09:00-17:00, M-FJob Posting

Sep 4, 2024, 4:31:06 PMFull-Time Salary Range

101275.2 - 168792Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment.

#J-18808-Ljbffr