Strategic Payer Analytics & Contracting Manager

CommonSpirit Health; Rancho Cordova (CA); On-site; USD 130,000 - 200,000; Full time

Job summary

CommonSpirit Health is seeking a System Manager, Payer to provide strategic leadership for payer relations and contracting across our network, ensuring financial performance and sustainable partnerships with health plans. You will lead a team responsible for negotiating, implementing, and monitoring contracts with governmental and commercial payers.

The role requires strong analytical and negotiation skills, deep knowledge of healthcare reimbursement, managed care, and regulatory requirements,

Qualifications

• Bachelor's Degree in Business Administration, Accounting, Finance, Healthcare or related field, or Equivalent education and experience in related field(s) may be considered in lieu of degree.
• Five (5) years of experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and/or healthcare operations.
• Two (2) years of experience in a supervisory role

Responsibilities

• Manage the labor and operations of the Payer Analytics & Economics team including the hiring, orienting, developing and managing of staff.
• Oversee quality control and quality assurance of Payer Analytics & Economics analytics deliverables and financial models to support the negotiation and implementation of appropriate reimbursement rates associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives.
• Review and accurately interpret contract terms, including payer policies and procedures to appropriately contract performance and influence strategic pricing strategies.
• Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability.
• Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
• Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provisions, parameters and rate structures aimed at establishing appropriate reimbursement levels. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities.

Skills

Payer analytics

Contracting leadership

Financial modeling

Negotiation

Regulatory knowledge

Education

Bachelor's degree in Business Administration, Finance, Healthcare or related field

Job description

CommonSpirit Health is seeking a System Manager, Payer to provide strategic leadership for payer relations and contracting across our network, ensuring financial performance and sustainable partnerships with health plans. You will lead a team responsible for negotiating, implementing, and monitoring contracts with governmental and commercial payers.

The role requires strong analytical and negotiation skills, deep knowledge of healthcare reimbursement, managed care, and regulatory requirements,