Job Overview:

Analytical Functions: Reporting to the VP, Managed Care or designee, the Manager, Managed Care Analytics plans, directs, and assumes accountability for Managed Care analytic functions, including a wide array of analytics related to payer performance and contracting impacts. Responsible for and manages internal Managed Care analytics team. Oversees payer reimbursement modeling and data analytic support for TriHealth Managed Care Contracting functions.Transforms claims and clinical data into actionable reports, designs and performs contract modeling and develops contract performance dashboards. The Manager, Managed Care Analytics also supports 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, maintains, and works collaboratively to have productive relationships with key stakeholders, both internal and external to the organization to ensure timely and accurate analyses. Fosters partnering relationships with Compliance/Corporate Counsel, Revenue Cycle, Decision Support, Patient Accounting, Medical Records, Managed Care Operations, etc. to provide data and analyses with accuracy. Acts upon daily and monthly revenue reports to identify and review variances and takes corrective action when needed.  Is a SME for Epic contract modeling, maintains Epic certification in this area, and is Epic knowledge resource for Managed Care analysts. Customer Service: Delivers excellent customer service to internal and external stakeholders and upholds TriHealth's mission.

Job Requirements:
 
Bachelor's degree, finance, economics, statistics, mathematics, IT/IS, business administration, public health, related field
Equivalent experience accepted in lieu of degree
Driver’s License
4-5 years experience Management finance, economics, mathematics, statistics, IT/IS, business administration, health administration, public health, related field
2-3 years experience Professional Business
 

Job Responsibilities:

Reporting to the VP Managed Care or designee, develop dashboards and ad-hoc reporting with minimal guidance in Excel/Tableau/PowerPoint; Perform complex data analysis and contract modeling support of ad-hoc, management, or executive requests. Collaborate with cross-functional teams, including clinical, technical and finance teams. Validate data extracts and analyze any data variances. Conduct service line managed care reimbursement analysis as requested by Management.
Work in conjunction with applicable teams to develop reimbursement models and validate model(s), monitor variances, take corrective action as needed. Manage the calculation and implementation of contract escalation language and system impacts. Identify and integrate data from multiple sources and build 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.
Develop and perform routine and ad-hoc reporting to evaluate performance and to identify opportunities for process improvements within the Managed Care Analytics department and other departments as applicable. Perform statistical analysis of data extracted from various internal sources and prepare reports based on findings.
Proactively identify data trends and outliers and provide 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.
Act as managed care analytics SME on multi-disciplinary teams charged with the maintenance development of enterprise-wide technical systems. Supervise, coach and mentor Managed Care Analyst(s); Proficiency with EPIC and other contract management, contract modeling, and electronic health record systems – Strong financial and analytical skills necessary to interpret complex quantitative information and relationships and prepare relevant and actionable reports that can be used by, including but not limited to, CFO, VP Managed Care, Managed Care department, Revenue Cycle, senior management of TriHealth, and/or other entities.
Detailed knowledge with both Medicare, commercial, and other governmental hospital, physician, and provider reimbursement methods (DRG, RBRVS, ASC, APC, Per Diem, Capitation, Fee Schedules, and Value Based reimbursement[desired]). ; Working knowledge of billing/coding terminology (i.e., ICD-10, CPT, Revenue Codes); 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. Ability to perform other duties as assigned.
Self-directed individual, with the ability to self-manage time and prioritize work across multiple priorities within a fast-paced business environment. Proficient with SAS, SQL server database, Microsoft Excel (including pivot tables), Microsoft Word, Power BI, or other tools as needed. Written and verbal communication skills necessary to elicit, negotiate, illustrate, and present technical information. Must possess a strong understanding of healthcare data including cost of care, patient utilization metrics, provider contract concepts and population health activities. Maintains compliance with HIPAA and regulations governing PHI.


Other Job-Related Information:

Direct Report FTEs = 0-2

Ability to mentor and develop direct reports. Working knowledge of healthcare reimbursement mechanisms, including hospital, ancillary, and physician payment systems. Understanding of billing and claims payment procedures is critical in this role.  Ability to think critically and with a high level of common sense. Strong customer service orientation, with the ability to partner effectively with individuals at all levels of the organization is necessary. Exceptional verbal, written communication. Ability to manage multiple priorities in a fast-paced environment.

Working Conditions:

Bending - Occasionally
Climbing - Rarely
Concentrating - Consistently
Continuous Learning - Frequently
Hearing: Conversation - Consistently
Hearing: Other Sounds - Consistently
Interpersonal Communication - Consistently
Kneeling - Rarely
Lifting <10 Lbs. - Occasionally
Lifting 50+ Lbs. - Rarely
Lifting <50 Lbs. - Rarely
Pulling - Rarely
Pushing - Rarely
Reaching - Rarely
Reading - Consistently
Sitting - Consistently
Standing - Consistently
Stooping - Rarely
Talking - Consistently
Thinking/Reasoning - Consistently
Use of Hands - Consistently
Color Vision - Occasionally
Visual Acuity: Far - Occasionally
Visual Acuity: Near - Consistently
Walking - Occasionally


Leadership Performance Standards

TriHealth leaders create a culture of engagement, safety & reliability and high performance by consistently modeling and utilizing the following TriHealth Way leadership competencies, tactics and ALWAYS Behaviors to drive strategic pillar results: 

Achievement of Annual Pillar Goals: 
1) Safety/Quality, 2) Service, 3) Growth, 4) Culture/People, 5) Finance 

Leadership Competencies: 
TriHealth Way of Leading 
TriHealth Way of Serving 
Transformation Change 
Drive for Results 
Build Organizational Talent

Leadership Tactics: 
Conduct department huddles. Generally, clinical departments hold daily huddles, non-clinical hold weekly huddles. 
Regularly Round on Team Members, using questions from the rounding log. 
- 25 or fewer team members = monthly 
- 26-50 team members = every other month 
- 51+ (and optional team members) = quarterly 

Lead monthly team meetings using meeting agenda template; review stoplight report; cascade key leadership messages. 

Model, coach and validate team members’ use of TriHealth Way behaviors (AIDET + Promise, Always Behaviors and Always HEARD). 

Recognize team members for safety wins, positive performance and demonstrating SERVE and ALWAYS behaviors, TriHealth Way of Leading, Serving and Delivering Care.