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CommonSpirit Health · 6 hours ago

System Manager Payer Analytics Economics

United States

Full-time

Remote

Mid, Senior Level

$47.41/hr - $62.81/hr

5+ years exp

CommonSpirit Health is one of the nation’s largest nonprofit Catholic healthcare organizations, delivering integrated health services. The System Manager, Payer will provide strategic leadership for payer relations and contracting, managing a team to negotiate and monitor contracts with health plans.

Health CareMedicalNon Profit

Responsibilities

Manage the labor and operations of the Payer Analytics & Economics team including the hiring, orienting, developing and managing of staff

Oversee quality control and quality assurance of Payer Analytics & Economics analytics deliverables and financial models to support the negotiation and implementation of appropriate reimbursement rates associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives

Review and accurately interpret contract terms, including payer policies and procedures to appropriately contract performance and influence strategic pricing strategies

Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability

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

Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods 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. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities

Qualification

Healthcare reimbursement methodologiesPayer contracting experienceFinancial analysisSQL queriesExcel proficiencySupervisory experienceManaged care experienceBusiness AdministrationStrategic planning

Required

Bachelors Other Bachelor's Degree in Business Administration, Accounting, Finance, Healthcare or related field. or Equivalent education and experience in related field(s) may be considered in lieu of degree

Five (5) years of 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 in the healthcare industry

Two (2) years of experience in a supervisory role

Requires some experience with SQL queries and Excel

Preferred

Strongly prefer hospital or managed care experience

EPIC experience a big plus

Company

CommonSpirit Health

Glassdoor3.6

Common Spirit Health is a healthcare organization that provides research programs, home health programs, and virtual care services. It is a sub-organization of CommonSpirit Health.

Founded in 2019

Chicago, Illinois, USA

10001+ employees