The Senior Managed Care Analyst provides support in negotiating and managing agreements with designated managed care organizations. The Senior Managed Care Analyst must participate in and prioritize multiple negotiations at one time to ensure the successful implementation of new agreements. The Senior Managed Care Analyst is part of all phases of the negotiation process and ensuring resolution to any issues that arise during the contract term. Typical activities include financial analysis and/or development of proposed reimbursement terms, rate modeling, reimbursement and contract negotiation, trouble-shooting contract issues and responding to requests for information/proposal.
Provides advanced consultative analytical support during commercial payer contract renewal negotiations by independently designing and implementing detailed predictive claims models and high level UNC System (facility and professional) predictive models that produce financial impact outcomes for use in strategic planning by Managed Care and executive leadership during payer negotiations. Acts as strategic and analytical consultant utilizing predictive analysis and business intelligence during the payer contract renewal process. Conducts complex ad hoc analysis as directed by leadership to include the evaluation of operational, clinical, quality and general business programs and processes. Solves business problems through statistical analysis/data validation, and communicates the outcomes of analysis to hospital/physician leadership, business owners, senior management, and corporate decision makers as necessary for use in strategic planning as well as management and operations control.
Develops effective key performance indicators, management dashboards and balanced scorecards that provide enhanced insight and improve organizational decision-making. Executes reports which aid in analysis of financial data to determine root causes of problems. Charts and tracks revenue-related changes (e.g. charges, receipts, third party sponsorship, collection rates) over time. Creates customized fiscal year receipts reports for each health care system entity that is communicated and delivered out to each CFO annually. Collaborates on a team of analytical experts from Hospital Revenue Cycle, ISD, and Enterprise Analytics & Data Sciences tasked with providing coordination, standardization, prioritization, best practices, and training for analytics for Hospital Revenue Cycle with the purpose to optimize, standardize, create, and empower the creation of analytical assets such as universes, reports & dashboards, and training & resources for hospital revenue cycle customers.
Serves on system-wide initiatives and reviews internal processes to improve operational efficiencies. Leads project teams to design, plan, and implement changes in operational processes to enhance current processes and develop more efficient processes. Acts as trainer, access permission gate keeper, and subject matter expert for all allowable rates and pricing. Develops and maintains tools/enhancements for internal customers in reference to allowable rates and pricing.
Acts as a key liaison between hospital leadership, physician leadership, other clinical leaders, ISD and other stakeholders. Serves as a guide of the organization’s business intelligence priorities to internal constituents through formal and informal communications. Develops concise, insightful, and politically savvy communications in PowerPoint, email and verbally via committee meetings, staff meetings, and working sessions. Creates and maintains pre- and post- contract renewal communications and financial analysis customized for each UNC entity and sent out to each CFO after completion of commercial payer negotiations. Presents pre-contract renewal analysis and strategic recommendations to each CFO in the UNC System and other executive leadership. Communicates directly with commercial payer provider network representatives during payer negotiations and after payer negotiations to ensure accuracy of contract renewal predictive models, to provide clarification on detailed negotiation requests, and to verify alignment and data validation on the implementation of annual UNC professional commercial rate changes. Attends and presents in, when applicable, monthly UNCHCS Managed Care CFO meetings. Participates in contract renewal negotiation meetings with the UNCHCS Managed Care team and commercial payer leadership and representatives.
Bachelor’s degree in relevant field. Requires five (5) years of experience with managed care contracts, data analysis or provider relations.
If Associate’s degree, requires nine (9) years of experience with managed care contracts, data analysis or provider relations.
If High School Degree, requires thirteen (13) of experience with managed care contracts, data analysis or provider relations.
Job ID: FIN002YJ