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Director - Payor Contract Analytics and Support

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Charlotte, NC, United States
Job ID: 24981
Job Family: Director/AVP (Dept Head)
Status: Full Time
Shift: Day
Shift Details: Regular
Department Name: 51011028341157-Contract Modeling and Support
Location: Atrium Corporate Operations

Overview

Job Summary

The Director, Payer Contract Analysis and Support, develops and maintains analytical tools, manages and trains staff, and uses data to provide recommendations on reimbursement methodology and rates for managed care contracts as well as on negotiation strategy.  The director will prepare financial analyses of current state, model the financial impact of potential reimbursement methods and rates, and determine the optimum structure and rates for MHR proposals during negotiations with managed care organizations.  Working primarily within MHR for the MHR management team, the Director, Payer Contract Analysis and Support is largely impacted by the managed care contracting cycle.  The Director, Payer Contract Analysis and Support, also has regular and frequent interactions with CHS Senior Management.



Essential Functions

Management/General Functions:

  • Direct team of professionals to meet the objectives of the department, division and System
  • Develop and maintain Payer portfolio analysis to support contracting strategy and negotiations including but not limited to enrollment information, profitability, and market competitive rates.
  • Manage multiple, complex projects using all available resources, while exercising good independent judgment toward meeting CHS goals and objectives.
  • Provide timely information in a fast- paced environment.
  • Understand and comply with HIPAA requirements for PHI security and disclosure.
  • Contribute membership and expertise to other organizational teams and committees as appropriate.
  • Focus on employee development by coaching and educating in areas including data integrity, reimbursement, coding/DRGs, Managed Care, Payment Reform, margins and other healthcare operations.
  • Ensure staff maintains detailed documentation of modeling criteria and results from modeling and analyzes.
  • Maintain documentation of policies, procedures, and decisions.
  • Manage departmental response to priorities
  • Establish standard review and QA processes to ensure accuracy in modeling and analysis. 
  • Review and document completed reports/projects for accuracy.

 

Contracting:

  • Lead team to create sophisticated, valid models for managed care financial terms.
  • Develop recommendations for optimum rate structure and terms to achieve departmental goals in negotiations.
  • Ensure staff works as part of the contracting team to provide changes to models and recommendations as needed during active negotiations within tight timeframes.
  • Lead staff to provide analysis of proposals received from payors.
  • Ensure staff regularly reviews performance of managed care portfolio and contracted payors using budgeted and modeled performance as benchmarks and highlighting performance issues or problems with key stakeholders including MHR Contracting, MHR Administration and Finance.
  • Lead team to develop and maintain fee schedules and rate documents working with Payors as needed to reconcile differences.
  • Communicate current rates/fees, in conjunction with negotiation team, to internal customers.
  • Collaborate with MHR infrastructure teams to determine appropriate data sources and data needed to support managed care analytics.

 

Physical Requirements

 

Performs most work under normal office conditions. Work may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles up to 25 pounds.



Education, Experience and Certifications

Bachelor’s Degree required, advanced degree, MBA or MHA preferred.  Minimum of seven years in health care finance, planning or managed care analytics experience in provider or MCO setting is required.  Must possess strong business analytical and statistical skills, understanding of healthcare reimbursement, and coding.  Must be proficient with large sets of data and be able to provide concise, clear deliverables for executive level use. Five years of successful experience managing professional staff in a dynamic environment is required. Expertise with personal computers and Microsoft Office Professional software required.  Expertise with decision support and database tools such as HPM/HBI, Access, SQL Server, Crystal Reports preferred.