Director Managed Care Analytics

Position Title :

Director Managed Care Analytics

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Department : Financial Services

Financial Services

Job Description :

General Description : Reporting to the SVP, Managed Care, the Director, Managed Care Analytics oversees payer reimbursement modeling and data analytic support to OU Health Managed Care Contracting functions, and transforms claims and clinical data into actionable reports, designs and performs contract modeling and develops contract performance dashboards.

The Director, Managed Care Analytics also participates in contract negotiations and actively manages financial components of active contracts and evaluates and provides key input into the determination of financial strategy for payer proposals in conjunction with Managed care leadership to ensure Managed Care goals are supported as well as viability factors for service lines and potential expansion of programs and health plan products.

This includes a support role in negotiations on an ongoing basis. Develops and maintain productive relationships with key stakeholders, both internal and external to the organization.

Essential Responsibilities :

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Developing dashboards and ad-hoc reporting with minimal guidance in Excel / Tableau / PowerPoint
• Performs complex data analysis and contract modeling support of ad-hoc and standing management or customer requests.
• Collaborates with cross-functional teams, including clinical, technical and finance teams.
• Validates data extracts and analyzes any data variances.
• Conduct service line managed care reimbursement analysis as requested by Management.
• Works in conjunction with applicable teams to develop value-based contract measures and metrics and applying such to reimbursement models and provider level tracking.
• Manages the calculation and implementation of contract escalation language and system impacts.
• Identifies and integrates data from multiple sources and builds reimbursement models, dashboards and reports within the various platforms, and other available reporting tools that produce interactive and effective data analytics in support of managed care contracting functions.
• Develops and performs routine and ad-hoc reporting to evaluate performance and to identify opportunities for process improvements.
• Performs statistical analysis of data extracted from various internal sources and prepares reports based on findings.
• Proactively identifies data trends and outliers and provides suggestions to the causes, remedies, or process improvements in compliance with payment regulation and market guidance.
• Responsible for data and information compilation, design, and analysis; developing and designing clear and concise reports for distribution to internal and external customers.
• Creates, and maintains business process and technical workflow documents.
• Acts as managed care analytics SME on multi-disciplinary teams charged with the maintenance development of enterprise-wide technical systems.
• Supervise, coach and mentor Manager, Managed Care Analytics.
• Performs other duties as assigned.

Minimum Qualifications :

Education : Bachelor degree in Business, Finance, Health Care, Economics or related field is required. MBA, MHA or related master's degree preferred.

Experience : 5 to 7 years of progressive leadership experience required, preferably within an academic medical center, multi-hospital health system or managed care organization (MCO), with demonstrated experience in healthcare analytics and medical economic modeling.

SQL, Tableau, and Strata experience preferred.

License(s) / Certification(s) / Registration(s) Required : Epic Resolute PB and HB certification required or must obtain both within 6 months of hire.

Knowledge, Skills and Abilities :

• Strong knowledge of hospital and physician reimbursement methodologies (i.e. DRG, per diem, fee schedule, APC)
• Working knowledge of billing / coding terminology (i.e. ICD-10, CPT, Revenue codes)
• Procedural knowledge of hospital and physician practice accounts receivable management
• SQL subject-matter-expert and focuses on combining, aggregating, and analyzing data queries.
• Proficiency with EPIC, Experian and / or other contract management, contract modelling, and electronic health record systems - Preferred
• Financial and analytical skills necessary to interpret complex quantitative information and relationships and distill them down to relevant and actionable reports that can be used by the Managed Care department, senior management of OU Health, and / or other entities.
• Detail oriented, with effective research and problem-solving skills. Ability to challenge results and quickly assess the validity, completeness and accuracy of data and analytics and recognize / communicate potential problem trends.
• Must possess a strong understanding of healthcare data including cost of care, patient utilization metrics, provider contract concepts and population health activities.
• A strong knowledge of medical coding (ICD, CPT) and business terminology.
• Detailed knowledge with both Medicare and commercial provider reimbursement methods (DRG, RBRVS, ASC, Per Diem, Capitation, and Value Based reimbursement).
• Ability to access data using information systems required to complete analysis and reporting requirements.
• Ability to understand OU Health custom database layout, format, and information usage.
• Proficient with SAS, SQL server database, Microsoft Excel (including pivot tables), Microsoft Word, Power BI, Python, other tools as needed.
• Demonstrated experience in manipulating data programs used in generating descriptive reports and in their corresponding analysis.
• Microsoft Office Suite advanced proficiency, particularly MS Excel, Access and PowerPoint.
• Written and verbal communication skills necessary to elicit, negotiate, illustrate, and present technical information.
• Team-oriented with strong communication, interpersonal and presentation skills.
• Ability to work with diverse groups of individuals in achieving required results and the interpersonal ability to efficiently interact with management, staff and outside entities.
• Self-directed individual, with the ability to self-manage time and prioritize work across multiple priorities within a stressful and demanding business environment.

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