Manages the analytical unit to support physician, hospital and ancillary group contracting efforts. Clearly defines and articulates business goals and objectives to maximize service to the Network Management Team. Builds and maintains senior level relationships internally and provides business advisory services that include model interpretation and recommendations based on relevant findings to drive the decision-making process. Leads analytics in development of new primary care reimbursement model. Oversees analytics in new risk sharing (ACO) models and expansion of value based purchasing. Oversees the processes to provide value-added, real time information to support provider fee schedule changes, hospital contract modeling and quantification of financial impact. Coordinates analysis to support provider initiatives and strategies, including but not limited to National Networks, ACOs, RHIOs, Tiered Networks, Medical Home Pilots and Capitation Models. Identifies opportunities to reduce medical costs, waste and inefficiencies and manages the quantification and tracking of cost containment initiatives. Enhances efforts to centralize competitive analysis using multiple sources of data and interacts with the RFP unit to provide relevant and timely information for fee schedules, claims repricing and competitive positioning. Provide appropriate staff development to create a strong analytical pool of analysts who can work independently and pursue personal growth as it pertains to their job. Ability to manage and motivate others using a team-oriented approach while managing expectations of exceptional performance. Perform annual performance appraisals with goal setting for direct reports and handles employee issues in conjunction with Human Resources. Perform other duties as assigned.
Minimum Education: Bachelor s degree in Business, Math, or statistics. Masters Degree preferred MBA, MPA, Health Services research.
Minimum Experience: 10 plus years experience in health care/managed care analytics or provider contract management. Must have supervisory experience.
" Strong leadership abilities, including the ability to work effectively in a matrix environment and lead multiple projects with cross functional teams
" Strong skills required in critical thinking, problem analysis, verbal and written communication, interpersonal interactions
" Health insurance or industry related experience with provider contract analysis/management
" Experience implementing new data analysis methodologies
" Ability to think strategically and provide appropriate analysis
" Excellent oral and written communication and interpersonal skills
" Understanding of and experience with CMS reimbursement methodologies
" Warehousing and Business Intelligence tool experience
" Spreadsheet and statistical tool experience
" Demonstrated understanding/application of research methodology, statistical analysis, and medical terminology.
MVP Health Care - 10 months ago
MVP Health Plan covers about 650,000 most valuable people. Also known as MVP Health Care, the company provides health insurance and employee...