Manager, Provider Network Informatics - Ohio, United States - Medical Mutual

Description

Manages operations and staff performing analytics for health plan provider contract negotiations, including Institutional, Ancillary and Professional modeling, analysis, and reporting. Oversees system administration for the provider reimbursement rate loading process, including quality control and testing.

Responsibilities

• Plans and manages the determination of appropriate rates for professional, ancillary and hospital contracts. Manages internal business relationships with Actuarial and Underwriting to determine how contracted rates will impact appropriate regions.
• Manages the analyses of payer value-based contract opportunities specific to capitated, bundled payments, and other emerging payment models to support the organizations drive toward alternative payment models.
• Plans and manages the rate loading process for provider contracts in assigned region. Manages internal business relationships with the Managers and/or Directors in the specified contracting regions.
• Ensures appropriate quality controls are in place through audits/tests to verify data integrity of rate loads and related information.
• Manages the preparation of monthly contract performance results and related financial reporting including interpretation and recommendations for improvement.
• Manages the completion of regular reports, as well as ad hoc reports to support Provider Contract Management, Underwriting and Actuarial, and other areas as necessary.
• Educates internal and external stakeholders about the terms and conditions of provider contracts and performance improvement opportunities.
• Performs other duties as assigned.

Qualifications - External

Qualifications

Education and Experience

• Bachelor's degree in business or health care administration, public health, finance, accounting, or related field.
• Master's degree preferred.
• 8 years progressive experience as a Provider Contract Analyst or equivalent experience in health care/managed care, 3 years of which are in a leadership role.

Technical Skills and Knowledge

• Comprehensive knowledge of and the ability to apply advanced concepts related to payer performance-based contracts, provider delivery systems, claims and clinical data.
• Superior financial analysis skills including forecasting and payment modeling.
• Intermediate to advanced Microsoft Office and database reporting skills.
• Knowledge of SAS programming.
• Excellent communication and presentation skills.
• Excellent organizational skills with managing projects and tight timeliness.