Manager, Payer Analytics Plantation, FL Business Office Full Time - Days Corporate Req #: 18860 Posted: Yesterday Apply Now Save Job Saved

Summary

Pediatric Associates was founded in Hollywood, FL in 1955. The same clinician-led, evidence-based, medical home passion is a unifying driver for those who join Pediatric Associates Family of Companies. The Pediatric Associates Family of Companies is a growing team of Pediatricians and Pediatric Care Teammates who are excited to be part of the first nationwide Pediatric Primary Care Medical Home. We further our uniqueness by ensuring the clinician voice is leading our medical home innovations.
 

Remote Opportunity

PRIMARY FUNCTION

The Manager, Care Payer Analytics is responsible for supporting contracting analysis and the development of financial models to support negotiations. This role will require collaboration with cross-functional teams, including managed care and FP&A.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

Develop and maintain FFS and value-based care pricing models which considers a variety of payer contracting terms and definitions. Develop sensitivity analysis on critical assumptions which impacts the contract profitability. Communicate findings with contracting leads to support negotiations. Develop and monitor FFS rates against benchmarks, identify outliers and make recommendations for contracting improvements. Develop and maintain payer P&Ls to track the overall contracted relationship across revenue streams and measure the impact of changes in contract terms. Monitor Medicaid market premium rate changes, population changes, and estimate the impact on expected contract reimbursement. Lead meetings with leadership to discuss the analyses generated, how analyses can improve payer partnerships, and support contract negotiations. Collaborate with the managed care and data organizations on required data transfers and the development of the internal consumption layers which enables value based care analysis and reporting.  This role will help ensure the consumption layers are accurate and controlled and will address file and field related issues such as ingestion, mapping, controls, and remediation. 

This role will involve moderately complex to complex issues where the analysis of situations requires in-depth data analysis and consideration of variable factors. Critical skills for this role will be possessing the ability to perform data analysis, development of reporting which enables identification of trends and underlying drivers which can impact contract performance. This role will require being flexible and a collaborative business partner in a growing organization.

QUALIFICATIONS

EDUCATION: Bachelor’s Degree in Business, Healthcare, or equivalent combination of education and work experience required.

EXPERIENCE: A minimum of 10 years of experience working in healthcare contracting.

KNOWLEDGE, SKILLS AND ABILITIES

Required qualifications:

Knowledge of provider reimbursement methodologies including FFS, pay for performance and value based care reimbursement structures Advanced technical skills and knowledge of healthcare data sets, payer claims data sets, and query languages Strong communication skills, including the use of exhibits and presentations to translate technical issues for non-technical audiences.

Preferred Qualifications, in addition to the required qualifications

7 years of experience in a value based care contracting Experience in monitoring the performance of provider contracts Experience in Managed Medicaid Experience with predictive modeling techniques to forecast future healthcare costs, utilization patterns, and population health outcomes. Ability to think holistically through a project

TYPICAL WORKING CONDITIONS

Non-patient facing Full time remote Job must be U.S. based

OTHER PHYSICAL REQUIREMENTS

Vision Hearing Sense of touch Manual Dexterity to operate a computer

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

  The Pediatric Associates Family of Companies an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Share: Apply Now