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Manager Reimbursement Analytics Finance

Finance | Franciscan Alliance

 

Address   Multiple Franciscan Work Locations Available

Calendar  Full-Time

Hours  Days
ROLE DESCRIPTION & PURPOSE

The Manager Reimbursement Analytics supports the Administrative Director Financial, Clinical, & Reimbursement in the day-to-day management, including providing modeling to support the negotiation and development of payer agreements or amendments, preparing and reporting ongoing payer yield reports that compared reimbursement to contracted levels, and creating and/or managing analytical tools to promote effective decision making and compliance to contract payment rates. This role also develops timely analysis associated with the reimbursement impact for modifications to the System’s charge master. S/he will model various reimbursement scenarios including capitation, percentage of premium, direct to employer, and other innovative payment models and evaluate performance while supporting the transition to valuebased reimbursement.

THE PAYGRADE FOR THIS POSITION IS: 119C

PRINCIPLE DUTIES
  • Support the System’s reimbursement strategies and initiatives through analysis of performance objectives and assessment of changes necessary for migration from a fee-for-service reimbursement to a riskbased reimbursement/capitation environment.
  • Oversee the timely preparation and distribution of payer yield reports to the site leadership
  • Manage the day-to-day development of financial and planning models to evaluate the impact of proposed reimbursement initiatives, contracts, amendments, payment disputes, and changes in regulation or provider manuals.
  • Assist with reimbursement modeling for new strategic projects or services and with managed care contract scenario modeling
  • Conduct the strategic reimbursement modeling to support changes to the charge master
  • Access rate schedules, product details, and historical claims to build and deploy model scenarios. Leverage multiple data points to provide visibility into all key model components
  • Provide expertise to reimbursement strategies including review of methodology options and coordination of appeal opportunities
  • Synthesize data, opportunities, issues & challenges, and articulates findings, conclusions, and recommendations
QUALIFICATIONS & EXPERIENCE
  • Bachelor’s Degree in business, statistics, information systems, healthcare management, or equivalent required with a relevant Master's degree preferred
  • 7+ years experience
  • Healthcare managed care modeling experience required
SKILLS & COMPETENCIES
  • Strong understanding of traditional managed care modeling, value based care modeling and scenario development
  • Excellent verbal and communication skills
  • Strong technology skills are critical, particularly expertise with Microsoft Excel, large volumes of multidisciplinary data sets
  • Self-starter who take initiative, possesses attention to detail, problem solves and is adaptable
  • Capability to extract required information from multiple data sources including EPIC, decision support systems, and financial applications
KEY CUSTOMERS
  • Admin Director Financial, Clinical, & Reimbursement
  • Senior Vice President, Finance/CFO, SVP of Strategy, CMO, SVP FPN and Innovation, Legal Counsel
  • Divisional CFOs, Operational Leadership, Division and site leadership

 

 

 

 

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

LEADERSHIP ​​​​

Multiple Franciscan Work Locat, Any, US, 0

Full-Time
Never or Rarely
employmentType:  Full-Time
Days
Multiple Franciscan Work Locat
Any
0
Any