Catholic Health Initiatives Manager Payment Transformation in ENGLEWOOD, Colorado

Manager Payment Transformation

Description

Job Summary

The Manager of Payment Transformation and Performance will take primary accountability for the contracted financial pricing performance and accounting for CHI providers in assigned markets and payers. Coordinates and provides value based contracting accounting and pricing expertise for the evaluation, negotiation, implementation and maintenance of value based contracts between CHI providers and payers or networks. Coordinates and monitors contract performance and accounting for senior leadership. Recommends and acts on strategies for maximizing reimbursement and market share. Develops new managed care products with external payors that are consistent with CHI’s strategic plans. Provides education to key stakeholders. Leads special projects for the senior leadership of the division as requested.

The nature and scope of this position is to be involved in and guide all financial aspects of value based 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 educational and problem-solving support. This position requires daily contact with senior management, physicians, 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.

Key Responsibilities

  • Lead strategic pricing analysts and managers, who support the negotiation and implementation of appropriate reimbursement rates and associated language, between physicians/hospitals and payers/networks in all managed care payer contracting initiatives. Develop and approve financial models and established negotiation procedures.

  • Assure satisfactory contract financial performance. Analyze and publish managed care performance statements and determine profitability. Drive strategies and solutions in order to maximize reimbursement and market share, which have multi-million or multi-billion dollar impact to CHI. Review and accurately interpret contract terms, including development of policies and procedures in support of contracts.

  • 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 risk and non-risk contracts and/or amendments/modifications using approved model contract language and following established negotiation procedures.

  • Act as a liaison between CHI and payer to update information and communicate changes.

  • Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and prepare complex financial reimbursement analyses and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provisions, parameters and rate structures aimed at establishing appropriate reimbursement levels.

  • Identify, collect, and manipulate from a wide variety of financial and clinical internal data bases (e.g., Star, TSI, PCON, Epic) and external sources (e.g., Medicare/Medicaid website). Identify and access appropriate data resources to support analyses and recommendations. Identify risk/exposure associated with various reimbursement structure options. Gather data and produces analytical statistical reports on new ventures, products, services, being considered. Perform sensitivity analyses on operating and underlying assumptions such as modifications of charges rates.

  • Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities.

  • Maintain knowledge of operations sufficient to identify causative factors, deviations, allowances that may affect reporting findings. Ability to translate operational knowledge to identify unusual circumstances, trends, or activity and project the related impact on a timely, pre-emptive basis.

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

Job Competencies:

In-depth Knowledge of:

  • Health care systems and inter/intra-relationships specific to value based contracting activities.

  • Hospital finance, information systems, marketing, and law

  • Complex managed care concepts and processes

  • Health insurance pricing and associated benefit designs

  • Provider billing and claims processing

Skills in:

  • Building credible relationships with multiple functions and manage in a complex matrix environment

  • Recruiting, training, and managing teams

  • Programming logic and statistical analysis

  • Spreadsheet, database, presentation, and word processing software

  • Interpersonal, presentation, communication and influencing

  • Management and interpretation of data

  • Negotiation

Ability to:

  • Strategically analyze and problem solve

  • Engage people and technology and lead projects from beginning to end

  • Read and interpret contract language and reimbursement mechanisms

  • Develop positive working relationships with senior management, physicians, hospital staff, and managed care company representatives

  • Communicate effectively with all levels of staff and customers

  • Demonstrate high level of self-directed motivation; professionalism; and trust

  • Handle multiple tasks on a daily basis

Qualifications

Job Requirements

Education / Accreditation / Licensure (required & preferred):

  • Bachelor's Degree in Business Administration, Accounting, Finance, Health Care or related field required.

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

Experience (required and preferred):

  • 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.

  • High level of technical understanding of GAAP accounting practices, value-based (e.g., HEDIS) quality measures, and government value-based programs (e.g., BPCI, MSSP)

Job Professional Non-Clinical

Primary Location COLORADO-ENGLEWOOD-DENVER INVERNESS

Daily Schedule 1

Scheduled Hours per 2-week Pay Period 80

Weekends Required Occasional

Req ID: 2018-R0162833

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.