Payor Operations & Analytics Manager

Riverside Health System • Newport News, VA

2d

About The Position

Assists with the development, strategic planning, and execution of managed care contracts for hospitals, medical groups, and ancillary providers. Provides enterprise level planning, development, implementation, and management of contractual relationships with payers; including accountable care organizations. Responsible for managing analytics readiness (integrity of modeling systems, payer trending, etc.) and financial analysis related to payer negotiations. Facilitates constructive payer relationships, coordinates operational changes to improve efficiency, identifies issues and initiates problem resolution. Manages daily operations of the Payer Relations team to include credentialing, issue resolution, research, payer monitoring, revenue integrity, contract maintenance, education, and communication to operational areas, quality, service lines, and IT for reimbursement, payer policies, and value based programs. Provides coaching and development for analysts. Plans, develops, implements and manages contractual relationships with payers to include ACOs. Responsible for analytics readiness. Manages the payer analytics team during all phases of managed care contracting. Develops complex payer contract models during negotiations and the ongoing analysis and reporting of payer performance and payment integrity. Coordinates operational changes to improve efficiency. Identifies issues and initiates problem resolution. Develops and maintains positive relationships with internal and external stakeholders. Ensures all departmental systems, reference materials, documentation, and databases are accurately maintained on a timely basis.

Requirements

• Bachelors Degree, Business, Finance, Accounting or related field (Required)
• 3-4 years Experience in hospital, health systems, large group or payer organizations with strong knowledge of healthcare reimbursement. (Required)
• Knowledge of managed care concepts and healthcare reimbursement.
• Negotiation skills for both contracting and resolution of payer issues.
• Strong analytical and computer skills; critical thinking, proficiency with contract modeling, analytical reporting tools, Excel and PowerPoint.
• Strong relationship management and communication skills; with the ability to work with all levels.
• Ability to lead a team and work collaboratively across multiple functioning departments and meet strict deadlines as appropriate.
• Strong relationship management, project management, and communication skills with the ability to work with all levels.

Nice To Haves

• Masters Degree, Business, Finance, Accounting or related field (Preferred)
• 1 year Supervisory experience (Preferred)
• Certified Specialist Payment & Reimbursement - Healthcare Financial Management Association (Preferred)

Responsibilities

• Manages daily operations of the Payer Relations team to include credentialing, issue resolution, research, payer monitoring, revenue integrity, contract maintenance, education, and communication to operational areas, quality, service lines, and IT for reimbursement, payer policies, and value based programs.
• Provides coaching and development for analysts.
• Plans, develops, implements and manages contractual relationships with payers to include ACOs.
• Responsible for analytics readiness.
• Manages the payer analytics team during all phases of managed care contracting.
• Develops complex payer contract models during negotiations and the ongoing analysis and reporting of payer performance and payment integrity.
• Coordinates operational changes to improve efficiency.
• Identifies issues and initiates problem resolution.
• Develops and maintains positive relationships with internal and external stakeholders.
• Ensures all departmental systems, reference materials, documentation, and databases are accurately maintained on a timely basis.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 1,001-5,000 employees