Manager Payor Analytics

Children's National Medical Center
United States, Maryland, Silver Spring
801 Roeder Rd #300 (Show on map)
Nov 16, 2024
Description The 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. Qualifications Minimum Education Bachelor's Degree Master's degree in Business Administration, Hospital Administration, Public Health Administration, or equivalent experience in a related field required. (Required) Minimum Work Experience 10 years At least 4-8 years of related health care experience with a minimum of 2 years supervisory experience in a related job function . Required Skills/Knowledge 1. Experience in and knowledge in healthcare payment systems 2. General knowledge of contract negotiation strategies, tactics and contract language 3. Strong creative and analytical skills for the development of contract terms, data interpretation, and contract analytics 4. Basic understanding of current payment market conditions and trends 5. Written and verbal communication skills 6. Understanding of a broad range of healthcare financial activities including third party reimbursement, revenue cycle, budgeting, and accounting 7. Knowledge and experience with technology tools in both large systems and with pc based products 8. Knowledge in Cost Reporting including payment components such as IME/GME, Capital, Bad Debt, Time Studies, etc. 9. Basic knowledge interpreting federal and state payment rules and regulations Functional Accountabilities Transform Department Vision and Strategy for optimal Performance 1. Support the directors with data for payer strategic direction with contracting and network development 2. Development of pricing methodologies in support of new programs or clinical business planning (i.e. value based, bundles, center of excellence, etc.) 3. 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 staff 4. Work with the contract managers and provide data that expands beyond our traditional service areas 5. Work to continually enhance, improve and assure optimal efficiency of this function Payer Relations Strategy Development 1. Assist with the evaluation of the economic impact of conditions, healthcare delivery options, legislations, competitors, state Medicaid agencies and the managed payer environment 2. Work with directors to ensure the department objectives are met 3. Support the payor negotiation process for new and existing contract relationships, ensuring data integrity to preserve CNHS's financial integrity 4. Identify area's to promote efficiency in the contracting process Payer Relationships and Reporting 1. Support a positive working relationships with Medicaid Agencies to address operational, contractual, or reimbursement/payment issues on a timely basis 2. Develop the analytic process that gathers, reviews, analyzes data reflecting payer performance to evaluate managed care relationships and state Medicaid agencies 3. Develop 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 settlements Management of Information Technology 1. Provide 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 performance 2. Actively use administrative and clinical information technology and decision-support tools in processes and performance improvement Organizational Accountabilities Primary Location : Maryland-Silver Spring Work Locations : Tech Hill 12211 Plum Orchard Drive Silver Spring 20904 Job : Non-Clinical Professional Organization : Finance Position Status : R (Regular) - FT - Full-Time Shift : Day Work Schedule : 09:00-17:00, M-F Job Posting : Sep 4, 2024, 4:31:06 PM Full-Time Salary Range : 101275.2 - 168792