Payor Strategy Manager

Job Requirements

Position Summary

Responsible leading development and execution of Spartanburg Regional Healthcare System's managed care analytics in support of contract negotiations and managing managed care agreements with payors on behalf of Spartanburg Regional Healthcare System (SRHS). This key position will participate as part Payor Strategy and Relations team negotiating contacts with payors. A high degree of professionalism is required due to the interaction of both internal and external contacts.

Minimum Requirements

Education

• Bachelor's Degree required, with major in Finance, Accounting or Business required.

Experience

• 3 years' experience in hospital or health plan managed care financial analytics role required
• Strong knowledge of MS Office products, with advance knowledge of Excel and Access. .
• Knowledge of SQL, SAS, or other database management tools.
• Familiarity with EPIC. Emphasis on billing systems.
• Working knowledge of managed care contract modeling tools required.
• Strong understanding current common coding practices including CPT4, ICD9CM, and DRGs
• Strong knowledge of current Commercial, Medicare Advantage, and Managed Medicaid reimbursement methodologies.
• In lieu of the education and experience requirements noted above, a Bachelor's degree in a discipline other the Finance, Business or Accounting if candidate has a MBA or CPA.

License/Registration/Certifications

• N/A

Preferred Requirements

Preferred Education

• N/A

Preferred Experience

• 5 years' experience preferred
• Power BI preferred
• EPIC user access certification preferred.
• Strata contract management system expertise preferred.

Preferred License/Registration/Certifications

• N/A

Core Job Responsibilities

The Manager of Payor Strategy and Relations must have strong analytical skills, good organization and communication skills, and the ability to manage multiple projects to meet aggressive deadlines. Demonstrates innovative and critical thinking with creative approaches to problem solving.

Payor Contract Negotiation Support (35%)

• Lead all analysis and financial impact modeling efforts to support payor contact negotiations. Present findings and make proposal recommendations.
• Build analytical models using Strata Contract modeling software and other tools (Excel, PowerBI, etc.) to evaluate financial impact of contract proposals for hospital, physician, home health, skilled nursing, outpatient ambulatory and other ancillary services provided by SRHS.
• Ability to distill data to salient information and recommendations and present findings of all analyses in a logical and concise manner.
• Expert knowledge of reimbursement terms and methodologies for Commercial, Medicaid, and Medicare product lines as well as familiarity with value-based incentive models.
• Manage payor analytic projects to as required by SVP and Director.
• Acts as primary liaison with payors for data analytics
• Working with SRHS Finance, insures accurate loading of payor reimbursement terms within EPIC.
• Identify and recommend revenue or market share growth opportunities through changes in pricing strategy or new pricing tactics.
• As requested, redline contracts, develop and negotiate amendments at the request of Director.

Payor Strategy Dashboards and Reports (35%)

• Build and manage reporting of Payor Strategy Commercial, Medicare, Medicaid, and Insurance Exchange Dashboards.
• Accountable for insuring payor databases of reimbursement rates and contract terms are accurate and updated.
• Produce reports to support leadership meetings as directed SVP and Director. Participate in leadership meetings as requested
• Manage production of Ad Hoc reports as requested.

Payor Strategy Development (15%)

• Work closely with SVP and Director, to develop and update SRHS's payor strategies to achieve SRHS goals and objectives, meet market changes, and explore new opportunities with payors.
• Work with SVP and Director and other key leaders providing analytic support for strategic chargemaster pricing and price transparency decisions.
• Work with SVP and Director in the annual SRHS budget process related to payor contracts.
• Assists in the development of Payor Strategy and Relations annual departmental goals.
• Oversee and develops benchmark studies and comparative market research needed to support Payor Strategy goals.
• Research pricing trends and provides recommendations on new approaches to address price transparency, shifts in the portfolio of services, trends in deductibles/co-insurance, new payment models, and value-based pricing.

Contract Compliance and Performance (5%)

• Develop and maintain reports and dashboards to monitor payor contract compliance and reporting (i.e., yield analysis, Joint Operating Committee performance metrics)
• Maintain Commercial, Medicare & Medicaid comparison payor reimbursement report.
• Participate, review, lead and provide financial analysis & utilization reports to support payor meetings including Joint Operating Committee and other meetings as directed by SVP or Director.
• Develop and design, in conjunction with SRHS Payor Strategy, SEHP and RHP team members reports and databases to support Payor Strategy and SRHS Population Health department goals.
• Support Director as needed in resolution of ongoing service issues with payors.

Team Support and Development (10%)

• Lead and support the Payor Strategy analytic team.
• Manage analytic team production. Prioritize projects to meet deadlines, ensuring final deliverables are complete and accurate.
• Support professional growth of staff.
• Develop a strong team player environment, prompt open effective communication, and constructively resolve internal and external conflicts.