POSITION PURPOSE This senior specialist provides leadership in relationship-building and problem-issue resolution within Managed Care. The role is responsible for managing relationships between payers, providers and its shared services customers and effectively resolving issues between providers and payers. It serves as a consultative resource and develops, establishes and manages relationships with executive leaders, key stakeholders, high-level professionals and decision makers (examples include CIN leadership, CFOs and financial leadership). The position is responsible for the quality and maintenance of the relationships between Trinity Health payer strategies and contracting, and contracted payers on an ongoing basis. The role collaborates with Mercy Health Network (MHN) leadership and analyst-teams to provide feedback to MHN senior leadership throughout each contract negotiation. It provides internal and external consultation regarding managed care and reimbursement strategies to MHN VPs, CFOs, PHO Directors, Service Line Directors and Administrators across the clinically-integrated delivery system. This position serves as a subject matter expert by providing guidance and problem/issue resolution to internal colleagues on matters impacting projects and day-to-day assignments. These work assignments, projects and/or duties as well as overall responsibility require an in-depth knowledge of payer-provider relationships and contracting. Strong relationship, communication and evaluative skills and the ability to contribute to and provide primary accountability for managing/leading small projects or portions of projects is expected. Assignments may require interfacing with gathering information from and making presentations to various levels of management and internal executive leaders.
Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision and Values in leadership behavior, practices and decisions.
Develop and maintain quality working relationships with Trinity Health Payer Strategies team, act as liaison with Corporate Legal department on contractlanguage issues, and collaborate with leadership throughout contract negotiations.
Lead joint operating committee meetings with Health Plan leadership to assess and address issues impacting the business relationship between the Plan and MHN, and provide internal and external consultation regarding managed care and reimbursement strategies to leadership across the clinically-integrated delivery system.
Analyzes, evaluates and interprets data, processes, systems, policies, regulations and internal controls. Conducts impact analyses and modeling, assesses trends, identifies risks, develops projections, determines opportunities and prepares detailed written summaries for management review and decision-making.
Utilizes integrated financial systems, relational databases, business intelligence and desktop analytical reporting tools to access data, develop detailed standard and ad-hocreports and summaries in order to support department and Payer Strategy and Product Development (PS&PD) projects and initiatives.
Participates in and serves as a subject matter resource in the development of process improvement initiatives which support business needs and enhance the performance of an operational area of revenue management.
Participates in defining project plans and goals; manages and/or leads small projects or portions of projects with limited impact. Performs business case ROI, conducts business workflow mapping, impact analysis, applies actions steps, provides routine status reports and keeps management apprised ensuring project plans and deliverables are met.
Assists in identifying operational and financial metrics and provides appropriate interpretation and application of data. Designs, develops, implements and maintains systems that provide financial, statistical and operational information.
Interfaces with internal management, leaders, MHN staff and stakeholders. Serves as a Subject Matter Expert (SME) and resource possessing the latitude to gather and exchange information and providing guidance and problem resolution on complex, challenging and variable situations that demand deep analytical, interpretive and evaluative thinking.
Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Bachelor’s degree in Business Administration, Finance, Accounting, Informatics or related field or an equivalent combination of education and related experience.
Minimum of five (5) years of progressively responsible operational or consulting experience in payer contracting .
Knowledge and experience of the healthcare industry or hospital financial operations.
Advanced proficiency with Microsoft product suite (MS Word, Excel, Power Point, Access and Visio), financial systems/software, relational database management and business intelligence reporting tools. Ability to utilize PC-based financial tools. (i.e., spreadsheets, databases, graphics, etc.)
Must possess a high degree of analytical, quantitative, evaluative and problem solving skills.
Considerable knowledge and experience supporting managed care contract negotiations and developing reporting and analytics for research and process improvement support.
Strong attention to detail and organizational skills. Demonstrated ability to manage multiple, concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments.
Ability to work independently and with minimal supervision. Ability to work in a team environment providing support to multiple positions. Ability to resolve problems and complete assignments accurately and promptly.
Excellent oral and written communication skills.
Ability to manage/lead small projects or portions of projects.
Demonstrated ability to respect confidential and sensitive information, understanding and honoring lines of accountability and communication is essential.
Knowledge of organization policies, procedures and processes.
Ability to operate in an ambiguous and matrix organizational structure. Ability to operate in a highly autonomous self-directed manner under frequently changing structures, requirements and priorities.
Must be comfortable operating in a collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Must be able to set and organize own work priorities, and adapt to them as they change frequently.
Must be able to travel to the various Mercy Health Network sites as needed.
Must possess the ability to comply with Trinity Health policies and procedures.
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.