GENERAL SUMMARY

The Director of Managed Care Analytics will be responsible for developing, implementing and coordinating managed care contracting including completing the data reporting and analytical needs for the Managed Care department. Provides complex, advanced evaluation of proposed and contracted payer rates. Directly supports department leadership in all payer and health plan contract negotiations for all Solaris Health Affiliates through detailed scenario modeling, comparative analysis, and benchmarking. Monitors contract performance and tracks key contract statistics for regular, periodic reporting, completes ad hoc analysis to support business needs, and provides primary assistance in the development of specific contracting strategies. 

ESSENTIAL JOB FUNCTION/COMPETENCIES

Responsibilities include but are not limited to:

• Understands and interprets contract terms, reimbursement schedules, patient accounting system(s) and other sources of data to complete analyses and financial projections.
• Builds complex data models used for contract rate negotiations with payers.
• Summarizes impact of proposals for department leadership and provides detailed analysis if necessary.
• Develops and completes specialized statistical and financial analysis reports on payer volumes, payments, contractual adjustments, administrative fees, etc.
• Facilitates maintenance of necessary grouper software/systems as applicable for the various Solaris Health entities, types of billed claims and patient-types.
• Completes ad hoc reporting as needed, e.g., pro forma, new business development, etc.
• Tracks various value-based care (VBC) contract payments, including shared-savings, incentives, and capitation.
• Completes reconciliation reporting validation as needed for VBC contracts.
• Collaborates with finance team and participates in the annual budgeting process, as it relates to system revenue changes.
• Participates in the development of the contract negotiation strategy including various reference reports, benchmarking parameters, etc.
• Prepares summary narrative reports, graphs, tables, charts, and illustrations.
• Implementation of new contracts and reporting.
• Assists in data collection for the completion of necessary payer credentialing applications.
• Performs other position related duties as assigned
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• N/A

KNOWLEDGE | SKILLS | ABILITIES

• Excellent verbal, written and interpersonal communication skills.
• Demonstrates strong leadership skills.
• Knowledge of managed care regulations and payment methodologies.
• Ability to keep financial records and perform mathematical tasks.
• Excellent organizational and multi-tasking abilities.
• Advanced Excel skills and functional knowledge of Microsoft Office Suite.
• Advanced financial modeling skills.
• Excellent problem solving and analytical skills.
• Strong business partnering skills and collaboration across multiple departments.
• Ability to update reports/dashboards and provide analysis.
• Knowledge of business Intelligence software.
• Familiarity with large scale ERP or G/L package (Great Plains).
• Complies with HIPAA regulations for patient confidentiality.

EDUCATION REQUIREMENTS

• Bachelor’s degree in Finance, Business or Health Administration.

EXPERIENCE REQUIREMENTS

• Minimum of 7 years of experience with health care, financial analysis and/or managed care contracts including health insurance operations and payment methodologies.

REQUIRED TRAVEL

• Occasional.

PHYSICAL DEMANDS

Carrying Weight Frequency

1-25 lbs. Frequent from 34% to 66%

26-50 lbs. Occasionally from 2% to 33%

Pushing/Pulling Frequency

1-25 lbs. Seldom, up to 2%

100 + lbs. Seldom, up to 2%

Lifting - Height, Weight Frequency

Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33%

Floor to Chest, 26-50 lbs. Seldom: up to 2%

Floor to Waist, 1-25 lbs. Occasional: from 2% to 33%

Floor to Waist, 26-50 lbs. Seldom: up to 2%