Manager, Healthcare Informatics

  •  

Pearland, TX

Industry: Healthcare

  •  

8 - 10 years

Posted 34 days ago

JOB SUMMARY

The Healthcare Finance (HCF) department exists to monitor and improve the financial performance of Kelsey-Seybold's (KS) product lines and health plans. The HCF Analytics team is a customer service-focused department providing consultation to the KS executive team as well as to select operational and functional departments. The HCF Analytics team works closely with internal and external partners to identify revenue and cost savings opportunities, support new product and business development, ensure regulatory compliance, inform contract negotiations and complete reconciliation of incentive arrangements, claims, capitation, and premium payments with other payers, vendors and/or government entities.
The HCF department is adequately staffed by highly skilled, motivated and inquisitive individuals that deliver complex analysis of financial and utilization data to support revenue enhancement and identify cost savings opportunities. The Manager will directly supervise a team of 3-5 analysts, closely collaborate with the Director and Vice President of Healthcare Finance to identify and define analysis and reporting requirements and provide analysis and data-driven recommendations to the Central Business Office, Pharmacy Services team, Sales and Marketing departments, HCC Coding team and others as required. The Manager is responsible for the review and analysis of all aspects of Kelsey-Seybold’s contracts with government and private payers and contracted providers utilizing underwriting skills, general health plan and managed care principles, and knowledge of healthcare finance.
Key responsibilities of this position include:
• Developing, producing, and analyzing reports and data required to understand the key drivers of the relevant business unit or service line
• Managing recurring activities to ensure timely and accurate payment and reporting and compliance with government or private payer reporting requirements
• Providing pricing support for provider group and Medicare Advantage plan
• Participating as a key member in strategy discussions and meetings with the KS executive team, third party payers, and employers

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)

Education

A.

Bachelor’s Degree in Finance, Economics, Mathematics, Healthcare Administration, or related field

B.

MBA or MHA preferred

Experience

A.

• 7+ years of experience in data analysis, decision support, medical economics, healthcare informatics, or managed healthcare
• 3 + years of experience supervising or managing teams and/or projects
• Demonstrated initiative and problem-solving skills
• Demonstrated ability to create and implement analysis/modeling that converts raw data into actionable business insights
• Demonstrated ability to analyze andreport on business units, products or service lines with minimalsupervision/direction

B.

• Experience in the healthcare industry and familiarity with healthcare systems (e.g., enrollment/eligibility, capitation, claims payment, etc.) with a Managed Care Organization (MCO)
• Knowledge of medical insurance products and basic underwriting concepts
• Experience with Medicare Part C or Health Insurance Marketplaces highly desirable, particularly with CMS risk adjustment models
• Experience in the healthcare industry with understanding of data in healthcare organizations (including claims data, ANSI 5010 837 data specifications, ICD10, Medicare Advantage, Health Insurance Marketplace, capitated payment models)

Licenses

A.

B.

Special Skills

A.

• Advanced proficiency in Microsoft Excel
• Basic knowledge of Microsoft Power Point and Microsoft Word
• 3+ years of programming experience in SQL, SAS or similar application language
• Experience writing, debugging and documenting complex queries against relational databases
• Experience participating in/leading system design and implementation initiatives

B.

• Experience with Statistical Software (including SAS, R, Minitab, SPSS)
• Experience with reporting tools (including Crystal Reports and Microsoft Access)
• Familiarity with EPIC and Clarityreporting data warehouse

Other

A.

• Fluent in English both verbal and written, effective communicator
• High level of accuracy with excellent attention detail
• Strong organizational and time management skills
• Proven ability to work in a dynamic setting and balance multiple priorities while meeting deadlines
• Superior analytical skills
• Ability to communicate complex information in a clear and concise manner
• Ability to motivate others and function as a working manager

B.

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