MedStar Health
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Managed Care Analytics Director
role at
MedStar Health .
General Summary of Position Oversees analytic functions supporting MedStar Health Managed Care Operations Department which performs reimbursement and financial analyses essential to contract negotiations and system initiatives. Prepares reports in response to business needs and develops and maintains databases. Actively participates in strategic discussions re. physician hospital and diversified company rate negotiations. Evaluates and provides key input into the determination of financial strategy for payer proposals in collaboration with Managed Care leadership to ensure Managed Care goals are supported. Develops reimbursement forecasts and monitors contract performance. Supports analytics for system-wide projects and workgroups.
Primary Duties and Responsibilities
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
Develops reimbursement models and reports in support of managed care contracting activities by utilizing a variety of platforms and other available reporting tools to produce interactive and efficient data analytics. Frequently interfaces with external payers regarding reimbursement models and analyses in support of contract negotiations.
Hires, trains and supervises financial analyst(s). Develops performance standards, evaluates performance and oversees personnel issues associated with staff. Ensures ongoing communication with his/her staff in accordance with MedStar values.
Monitors payer performance and oversees profiling and reporting regarding payer utilization, profitability and financial trends including benchmarking payers against Medicare and each other.
Oversees external market analyses. Compiles published financial and utilization information re. managed care companies. Profiles competitors or competitive clinical services. Develops a global assessment of the regional health care market to influence internal strategic decisions regarding program development and rate methodologies.
Performs ad hoc financial reporting as needed with minimal guidance and remains current on the latest healthcare issues and reimbursement trends. Validates data extracts and analyzes any discrepancies.
Performs other duties as assigned for both Managed Care staff and for MedStar Associates in other departments including Finance Planning and Diversified.
Serves as a key member of interdisciplinary teams (physicians, finance and administrators) to provide operational and contract support for carve-outs including understanding the process flow and making recommendations for changes to improve efficiency and maximize reimbursement; develops and updates business rules for distribution to global billing company; conducts reporting on financial outcomes and prepares reports for regulatory agencies as needed. Acts as trouble‑shooter, interfaces with internal billing groups, providers and payers to resolve problems.
Serves as primary contact and resource with Finance (including Patient Accounts and Patient Financial Service) regarding contract interpretation, coding requirements and other managed care reimbursement issues.
Serves as primary contact with billing departments and/or external billing companies to secure, analyze and report physician utilization and reimbursement rates.
Structures, coordinates, consolidates and presents financial and statistical information related to Managed Care Operations to ensure complete, accurate and timely financial reporting to management. Scope includes hospital physician, diversified business and global reporting.
Understands functioning data requirements and revenue implications of various hospital and physician payment methodologies including Medicare IPPS, OPPS, RBRVS systems; and Medicaid fee‑for‑service and capitation arrangements.
Works with internal clients to resolve issues, recommends process improvement regarding reimbursement issues and recommends future contract changes to enhance reimbursement and overall contract performance.
Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multi‑disciplinary quality and service improvement teams.
Minimal Qualifications Education
Bachelor's degree in Healthcare Administration, Finance, Business Administration or related field required.
Master's degree (MBA, MHS or other graduate degree with a health care or information systems concentration) preferred.
Knowledge of healthcare delivery settings, clinical data management and health care insurance required.
Experience
5–7 years in healthcare analytics, database management and information management. Managed care payor or multi‑hospital health system reimbursement experience required.
Licenses and Certifications
No special certification, registration or licensure required.
Knowledge, Skills and Abilities
Project management, strategic and tactical planning and problem‑resolution skills.
Excellent communication skills for effective executive team interaction.
Advanced proficiency with Microsoft product suite (Word, Excel, PowerPoint, Access) and standard project management software.
Detailed knowledge of Medicare and commercial provider reimbursement methods (DRG, RBRVS, ASC, Per Diem, Capitation and Value‑Based reimbursement).
A solid understanding of medical coding (ICD, CPT) and business terminology.
Ability to access data through different systems to complete analysis and reporting requirements.
Advanced knowledge of Microsoft Office Suite, particularly Excel and Access.
Self‑motivated individual capable of managing time and prioritizing work across multiple priorities in a demanding business environment.
Ability to work with diverse groups of people to achieve desired results and interpersonal skills to interact effectively with management staff and outside entities.
This position has a hiring range of USD $114,004.00 - USD $219,960.00 /Yr.
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Managed Care Analytics Director
role at
MedStar Health .
General Summary of Position Oversees analytic functions supporting MedStar Health Managed Care Operations Department which performs reimbursement and financial analyses essential to contract negotiations and system initiatives. Prepares reports in response to business needs and develops and maintains databases. Actively participates in strategic discussions re. physician hospital and diversified company rate negotiations. Evaluates and provides key input into the determination of financial strategy for payer proposals in collaboration with Managed Care leadership to ensure Managed Care goals are supported. Develops reimbursement forecasts and monitors contract performance. Supports analytics for system-wide projects and workgroups.
Primary Duties and Responsibilities
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
Develops reimbursement models and reports in support of managed care contracting activities by utilizing a variety of platforms and other available reporting tools to produce interactive and efficient data analytics. Frequently interfaces with external payers regarding reimbursement models and analyses in support of contract negotiations.
Hires, trains and supervises financial analyst(s). Develops performance standards, evaluates performance and oversees personnel issues associated with staff. Ensures ongoing communication with his/her staff in accordance with MedStar values.
Monitors payer performance and oversees profiling and reporting regarding payer utilization, profitability and financial trends including benchmarking payers against Medicare and each other.
Oversees external market analyses. Compiles published financial and utilization information re. managed care companies. Profiles competitors or competitive clinical services. Develops a global assessment of the regional health care market to influence internal strategic decisions regarding program development and rate methodologies.
Performs ad hoc financial reporting as needed with minimal guidance and remains current on the latest healthcare issues and reimbursement trends. Validates data extracts and analyzes any discrepancies.
Performs other duties as assigned for both Managed Care staff and for MedStar Associates in other departments including Finance Planning and Diversified.
Serves as a key member of interdisciplinary teams (physicians, finance and administrators) to provide operational and contract support for carve-outs including understanding the process flow and making recommendations for changes to improve efficiency and maximize reimbursement; develops and updates business rules for distribution to global billing company; conducts reporting on financial outcomes and prepares reports for regulatory agencies as needed. Acts as trouble‑shooter, interfaces with internal billing groups, providers and payers to resolve problems.
Serves as primary contact and resource with Finance (including Patient Accounts and Patient Financial Service) regarding contract interpretation, coding requirements and other managed care reimbursement issues.
Serves as primary contact with billing departments and/or external billing companies to secure, analyze and report physician utilization and reimbursement rates.
Structures, coordinates, consolidates and presents financial and statistical information related to Managed Care Operations to ensure complete, accurate and timely financial reporting to management. Scope includes hospital physician, diversified business and global reporting.
Understands functioning data requirements and revenue implications of various hospital and physician payment methodologies including Medicare IPPS, OPPS, RBRVS systems; and Medicaid fee‑for‑service and capitation arrangements.
Works with internal clients to resolve issues, recommends process improvement regarding reimbursement issues and recommends future contract changes to enhance reimbursement and overall contract performance.
Participates in meetings and on committees and represents the department and hospital in community outreach efforts. Participates in multi‑disciplinary quality and service improvement teams.
Minimal Qualifications Education
Bachelor's degree in Healthcare Administration, Finance, Business Administration or related field required.
Master's degree (MBA, MHS or other graduate degree with a health care or information systems concentration) preferred.
Knowledge of healthcare delivery settings, clinical data management and health care insurance required.
Experience
5–7 years in healthcare analytics, database management and information management. Managed care payor or multi‑hospital health system reimbursement experience required.
Licenses and Certifications
No special certification, registration or licensure required.
Knowledge, Skills and Abilities
Project management, strategic and tactical planning and problem‑resolution skills.
Excellent communication skills for effective executive team interaction.
Advanced proficiency with Microsoft product suite (Word, Excel, PowerPoint, Access) and standard project management software.
Detailed knowledge of Medicare and commercial provider reimbursement methods (DRG, RBRVS, ASC, Per Diem, Capitation and Value‑Based reimbursement).
A solid understanding of medical coding (ICD, CPT) and business terminology.
Ability to access data through different systems to complete analysis and reporting requirements.
Advanced knowledge of Microsoft Office Suite, particularly Excel and Access.
Self‑motivated individual capable of managing time and prioritizing work across multiple priorities in a demanding business environment.
Ability to work with diverse groups of people to achieve desired results and interpersonal skills to interact effectively with management staff and outside entities.
This position has a hiring range of USD $114,004.00 - USD $219,960.00 /Yr.
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