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    AVP, Provider Contract Analytics - Jacksonville, United States - CareSource

    CareSource
    CareSource Jacksonville, United States

    2 weeks ago

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    Description

    Job Summary:


    The Associate Vice President, Provider Contract Analytics oversees the Provider Contract Analytics area focusing on providing analysis and modeling regarding health partner contracts.


    Essential Functions:
    Oversee financial and analytical functions focused on institutional claim re-pricing and contract performance, professional claim re-pricing and contract performance, and provider performance analytics solutions
    Develop the talent of a diverse team of healthcare analysts and systems analysts with expertise in provider reimbursement, contract modeling, and provider data with a high-degree of financial acumen
    Drive financial oversight of provider contracting for efficient and effective unit cost across service categories through process gates and analytics (benchmarking, best practice contract terms)
    Continuously investigate opportunities for contracting improvements with existing partners and identifies areas for network optimization. Identifies issues related to reimbursement and recommends appropriate solutions
    Identify and translate into action plans industry best practices for contracting, including contract structure, modeling, and reporting
    Actively participate in operational calls with key providers or network partners as needed
    Develops and provides actionable recommendations to senior management relative to all analysis and/or ad hoc reporting
    Track and report historical results of network optimizations
    Ensure all governing body regulations are adhered to at all times for existing and future lines of business
    Partner with leadership to define the strategic direction of the team
    Responsible for the budgeting and forecasting processes of department
    Build and strengthen provider relationships by facilitating quality service
    Ensure integrity of information obtained for analysis; keep up-to-date knowledge of the technical systems, claims processing initiatives, and CareSource payment policies
    Provide guidance and mentorship to analysts
    Perform any other job duties as requested

    Education and Experience:
    Bachelor of Science/Arts Degree in accounting, finance, economics, computer sciences or related field or equivalent work experience is required
    Masters or other advanced degree in related field is preferred
    Minimum of ten (10) years of professional level experience performing a broad range of data analysis required, preferably in healthcare contracting and/or financial field
    Minimum of five (5) years of management experience required
    Minimum of two (2) years of director level experience preferred
    Provider contracting experience is preferred
    Managed care or healthcare experience is preferred

    Competencies, Knowledge and Skills:
    Advanced proficiency with Microsoft Suite to include Word, Power Point and Outlook
    Expert proficiency with Microsoft Excel
    Intermediate knowledge of SQL, SAS, R or other statistical software
    Knowledge of health care reporting standards
    Ability to work independently and to manage multiple priorities with limited resources
    Ability to effectively report data, analyze facts, and exercise sound business judgement when making recommendations
    Ability to analyze problems, draw conclusions, develop processes and communicate status and results
    Excellent oral and written communication skills
    Ability to interact with executive levels of management as well as external stakeholders
    Auditing skills
    Strong interpersonal, leadership and relationship building skills and high level of professionalism
    Ability to lead and direct the work of others including the development motivation and rewarding of staff

    Licensure and Certification:
    None

    Working Conditions:
    General office environment; may be required to sit or stand for extended periods of time

    Compensation Range:
    $150,000 - $300,000. CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

    Compensation Type:
    Salary

    Competencies:
    #J-18808-Ljbffr
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