Catholic Health Initiatives Manager of Healthcare Economics & Strategic Pricing in ENGLEWOOD, Colorado

Manager of Healthcare Economics & Strategic Pricing

Description

Spirituality in the Workplace

  • One of our four feast days, the Spirituality at Work Feast Day celebration happens around Labor Day. During this celebration, we recognize not only why we work, but also those we are blessed enough to work with.

Job Summary:

  • The Manager of Healthcare Economic & Strategic Pricing will take primary accountability for managed care contract financial performance for CHI providers in assigned markets and payers. Coordinates and provides analytical and pricing expertise for the evaluation, negotiation, implementation and maintenance of managed care contracts between CHI providers and payers or networks. Coordinates and monitors contract performance and compliance. Recommends and acts on contract compliance strategies to maximize reimbursement and value. Analyzes and provides education to key stakeholders on contract terms and payer policies and protocols impacting reimbursement. Leads special contract compliance projects for national and divisional leadership as requested.

Essential Duties

  • Lead strategic pricing and contract compliance analysts that perform contract modeling and payment integrity activities for managed care payer contracting initiatives

  • Lead contract management and contract modeling for the CHI physician enterprise

  • Develop, test and approve financial models and operational processes to monitor managed care contract performance and enforce contract compliance.

  • Assure satisfactory contract financial performance. Analyze and publish managed care contract performance. Drive strategies and solutions in order to maximize reimbursement. Review and accurately interpret contract terms, including payer policies and protocols, to determine expected reimbursement.

  • Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.

  • Analyze terms of new and existing contract language, reimbursement methodologies and payer policies and protocols.

  • Oversee the identification, collection, and manipulation of data within multiple contract modeling tools, billing systems, and databases (e.g., Payment Integrity Compass, EPSI, EPIC) and external sources (e.g., Medicare/Medicaid websites).

  • Assess risk/exposure associated with various reimbursement structure options and develop models, reports and tactics to ensure compliance with contracted reimbursement structures.

  • Prepare and effectively present results to Payer Strategy & Operations leadership, and other key stakeholders, for review and strategic planning activities.

  • Maintain knowledge of industry trends, payer policies and protocols, and revenue cycle operations to support effective contract compliance activities.

  • Prepare routine reports and ad-hoc analyses as directed, with ability to accurately reflect actual vs. expected contract performance trends.

  • Maintain knowledge of industry trends, payer policies and protocols, and revenue cycle operations to support effective contract compliance activities.

  • Prepare routine reports and ad-hoc analyses as directed, with ability to accurately reflect actual vs. expected contract performance trends.

Qualifications

Skills and Qualifications:

Education/ Accreditation/ Licensure (required & preferred):

  • Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare or related field required.

  • MBA, MHA, MHSA, or equivalent work experience desirable

Experience (required and preferred):

  • 7-10 years

  • Seven or more years extensive experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations

  • High level of technical understanding and proficiency in SQL, Oracle, MS Access, MS Visual Basic, C , SAS, MS Excel, or other related applications

  • Knowledge and expertise related to all aspects of managed care reimbursement methodology

  • The nature and scope of this position is to be involved in all aspects of contracts from beginning to end, including the initiation, evaluation, negotiation, re-negotiation implementation, maintenance and termination of contracts

  • This position provides a critical liaison and negotiating arm for CHI hospitals and physicians, which has a profound impact on the organization

  • This position will serve all stakeholders through on-going education and problem-solving support

  • This position requires daily contact with senior management, physician, hospital staff, and managed care company leaders

  • The position must handle adverse and politically difficult situations, as managed care negotiations have a direct impact on individual physician incomes, along with directly impacting the financial performance of CHI

  • Outside meetings with physicians and senior executives from external payers is frequent

  • This person must take accountability for designated reimbursement modules and systems and must be proficient in reading, interpreting and formulating complex computer system rules

Job Professional Non-Clinical

Primary Location COLORADO-ENGLEWOOD-DENVER INVERNESS

Other Locations ILLINOIS-SCHAUMBURG, KENTUCKY-LEXINGTON, TEXAS-HOUSTON, TENNESSEE-CHATTANOOGA

Daily Schedule 1

Scheduled Hours per 2-week Pay Period 80

Weekends Required None

Req ID: 2018-R0164405

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.