Payor Analytics Manager

PURPOSE AND SCOPE:

Responsible for managing all aspects of payor negotiation analytics in the assigned Group(s). This involves the monitoring analysis and evaluation of pertinent financial and competitive data; detailed tracking and follow-up of all assigned payor negotiations.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Responsible for timely and accurate communication of executed payer agreements to Operations management and Revenue Centers.
• Responsible for compliance with all related data collection and auditing activities as well as contract implementation analysis and new contact performance monitoring.
• Responsible for monitoring profitability of current payor contracts and identifying potential negotiation targets.
• Responsible for evaluating non-contracted positions to identify potential growth opportunities.
• Responsible for tracking contract escalators.
• Responsible for assisting with all budgetary reviews of all financial changes to existing and future agreements.
• Perform various financial analyses to assist with contract proposals contract terminations payor consolidation including analysis of Standard Carrier claims data obtained using current financial data systems analysis of medication utilization for global contracts and analysis of rate structure conversion.
• Produces analytical reports to support managed care efforts on a monthly or as needed basis
• Performs analysis of network data for growth as required.
• Performs and maintains competitive analysis of individual markets and competitive provider activity.
• Collaborate with departmental peers to develop best practices for daily activities.
• Technically proficient in the specific department and knowledge of industry practice and business principles. Works on issues of diverse scope where analysis of situation or data requires evaluation of a variety of factors including an understanding of current business trends.
• Experience required for a multi-faceted environment; role primarily focuses on tactical execution. Receives assignments in the form of objectives and determines how to use resources to meet schedules and goals.
• Program or project responsibility generally within the function. An individual contributor will have significant project/process responsibilities.
• Follows processes and operational policies in selecting methods and techniques for obtaining solutions. Interprets and recommends change to policies and establishes procedures that affect business processes.
• Decisions have an impact on work processes and outcomes. Erroneous decisions or failure to achieve results will add costs and may impact the short-term goals of the organization.
• Frequently interacts with supervisors customers and/or functional peer group managers normally involving matters between functional areas other company divisions or units or customers.

• Participates in meetings with internal and external representatives. Interacts with internal departments and external customers; particularly in problem resolution.
• Provide technical guidance.
• Assist with various projects as assigned.

• Other duties as assigned.
• Review and comply with the Code of Business Conduct and all applicable company policies and procedures local state and federal laws and regulations.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS :

• The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SUPERVISION:

• May be responsible for the direct supervision of various levels of department staff.

EDUCATION :

• Bachelors Degree required; Advanced Degree desirable

EXPERIENCE AND REQUIRED SKILLS :

• 5-8 years related experience ; or a Masters degree with 3 years experience
• 3 years supervisory or project/program management experience preferred.
• Knowledge of Generally Accepted Accounting Principles (GAAP) highly preferred
• Strong computer skills with demonstrated proficiency in word processing spreadsheet database and email applications.
• Detail oriented with strong analytical and organizational skills.
• Strong oral and written communication skill to effectively communicate with all levels of management.

Required Experience:

Manager