This position is responsible for providing analytical support for the Managed Care department that involves synthesizing data from multiple sources into clear, meaningful negotiation and decision making tools. Responsibilities include developing a local managed care utilization database, producing contract performance reports, modeling reimbursement rates, evaluating and quantifying financial contract modifications and compiling and monitoring key managed care statistics. This position will serve as a managed care resource for internal departments (i.e. patient financial services and decision support).
Dignity Health and Sponsoring congregations are committed to furthering the healing ministry of Jesus. Resources are dedicated to: delivering compassionate, high-quality, affordable heath services; serving and advocating for our sisters and brothers who are poor and disenfranchised; and collaborating with others in the community to improve the quality of life.
· Access, extract, analyze and maintain utilization data from various managed care information systems for the purposes of modeling and reporting financial statistics to drive managed care strategy and decision making.
· Model contract reimbursement terms to determine expected financial impact of contract modifications and charge master effects, with a high degree of accuracy and speed.
· Develop and generate reporting templates for monitoring managed care contract performance (both capitation and FFS) including, but not limited to:
Evaluate and respond to data/statistical reporting requests from hospitals, division and system offices and working closely with Manager, Managed Care Analytics to coordinate local market efforts in support of statewide payer negotiations.
- P&L statements
- Comparisons of expected yield to actual yield
- Comparison of actual yield to cost
· Create, establish and ensure maintenance of ongoing tracking and reporting systems and methodologies in order to measure and document results of contract negotiations.
· Monitor and ensure that sound financial modeling practices are utilized and tools developed by the Managed Care Department are consistently applied to accurately calculate Dignity Health’s managed care expected revenues.
· Direct report to Manager, Managed Care Analytics
· Corresponds with Hospital Managed Care Field Representatives, Directors and Managers
· Corresponds with Hospital Level Decision Support Teams and Business Office Teams
· Corresponds with Third Party Payors and Managed Care entities (HMOs, PPOs, et al), governmental agencies involved in contracting and managed care
· 5 years experience in a healthcare financial setting (provider or health plan-based) with progressive responsibility
· Comparable combination of education and experience
· Bachelors degree from an accredited university with an emphasis in healthcare, finance or a related field
Special Knowledge, Skills, Abilities
· Healthcare reimbursement methodologies
· Healthcare coding methodologies (DRG, APC, RBRVS, ICD-9 and HCPCS)
· Proficient in database management
· Healthcare industry trends
· Financial analysis techniques
· Effective management and communication skills
· Knowledge of hospital based information systems and programs
· Advanced knowledge of Excel, Access and WORD or equivalents
Dignity Health, headquartered in San Francisco, Calif., provides integrated, patient and family centered care. It is the fifth largest health system in the country with 10,000 physicians and 55,000 employees across Arizona, California, and Nevada. Through its network of more than 150 ancillary care sites and 40 acute care hospitals, Dignity Health is committed to delivering compassionate, high-quality, affordable health care services with special attention to the poor and underserved. In 2011, Dignity Health provided $1.4 billion in charity care, community benefit and unreimbursed patient care. For more information, please visit our website at www.dignityhealth.org . Dignity Health is also on Facebook and Twitter.
With a growing network of hospitals throughout Arizona, California and Nevada, Dignity Health offers a spectacular array of career...