Manager of Payor Contracting Analytics - Corporate

Manager of Payor Contracting Analytics - Corporate | Summit Healthcare Mgmt | Franklin, Tennessee

About the Job:

Key to all contracts with Health Plans is effective reimbursement implementation. The Manager-Payor Contracting Analytics performs three key roles; 1) All reimbursement contracts require robust and detailed pricing analytics that coordinate vast amounts of data into market and portfolio competitive pricing proposals; 2) all contracts must be properly tracked and managed through each stage of execution; and 3) all contracts must be properly loaded with downstream accounting and billing systems, so reimbursement for provided services is captured effectively. The Manager-Payor Contracting Analytics will also work side-by-side with the SVP-Payor Engagement and be a subject matter expert (SME) using the contract lifecycle management (CLM) system, assisting with training other users, conducting payor pricing analytics, lead issue resolution with Revenue Cycle teams, handle information requests, maintain contracting tools and databases, and assisting with special project initiatives. The Manager-Payor Contracting Analytics will also coordinate county-specific contract negotiations and execution in select states. This function will require understanding of multi-state participation requirements and state-specific rules and regulations.

Roles and Responsibilities:

• Develop pricing proposals, manage pricing databases, and develop pricing analytics reporting. Advanced Excel skills are required to consolidate data and produce competitive proposals predicated on market and existing payor portfolio financial information.

• Coordinate and track contracts initiated by the Payor Engagement team to ensure final signature and execution.

• Coordinate and verify with downstream accounting and billing systems that reimbursement pricing is correctly loaded. Previous experience with Revenue Cycle functions and documentation required.

• Support issue resolution projects with the Revenue Cycle Management department with a particular focus on root-cause analysis of system configuration alignment with executed payor contract terms and conditions. Previous experience leading health plan joint operating committee meetings is highly valued.

• Lead and coordinate contract negotiation in key states where County governments are material source of facility reimbursement. Previous experience working with County governments and knowledge of funding mechanisms and contract requirements is strong qualification for this role.

• Assist the SVP-Payor Engagement in developing and managing other reimbursement sources such as federal and state grants and supplemental funding pools for indigent and low-income patients.

• Strong background in education internal constituents of contract terms, conditions, and implications for their department.

• Enter and update payor agreements, amendments, and other contract documents to contract management system (serving as key support to the Contract System Administrator).

• Track and report on status of contracts within the corporate review process to ensure timely contract approvals and final signature. Role may require financial and contractual presentations to senior leadership.

• Maintain key databases that track reimbursement and contract effective dates with health plans.

• Retrieve, organize, and report from multiple sources and databases information that supports contracting decision-making.

• Conduct payor market research utilizing externally sourced databases. Serve as reference in evaluation of externally sourced databased for adoption by organization.

• Construct, prepare, and develop agendas for issuance of regular payor communications and PowerPoint presentations regarding facility and company outcomes and accomplishments.

• Maintain all contracting tools and resources to be current and complete.

• Support development and administration of staff education programs, with material design, generation and tracking.

Education/Experience/Skill Requirements:

• Bachelor’s degree in healthcare administration preferred.

• Three or more years’ experience in payor engagement, revenue cycle management, or other pricing analytics.

• Strong knowledge of the credentialing process, regulatory requirements, and payor guidelines.

• Familiarity with electronic credentialing platforms and healthcare databases.

• Detail-oriented with exceptional organizational skills and the ability to manage multiple tasks simultaneously.