Where You’ll Work
Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.
Job Summary and Responsibilities
As our System Manager, Payer, you will provide strategic leadership and expert oversight for all aspects of our organization's payer relations and contracting, ensuring optimal financial performance and sustainable partnerships with health plans. Every day you will manage a team responsible for negotiating, implementing, and monitoring contracts with various governmental and commercial payers across our system. To be successful in this role, you must possess strong analytical and negotiation skills, a comprehensive understanding of healthcare reimbursement methodologies, managed care models, and regulatory requirements, and proven leadership experience in payer contracting and relations within a complex healthcare environment.
- 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.
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Job Requirements
Required
- Bachelors Other 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, and/or healthcare operations
- Two (2) years of experience in a supervisory role
- Strongly prefer hospital or managed care experience
- Strongly prefer some experience with SQL queries and strong Excel. EPIC experience a big plus.
