PRIMARY RESPONSIBILITIES:

• Facilitates the acquisition of value-based payer information and data files (claims, eligibility, financial reports, physician rosters, etc.); ensure all necessary quality assurance activities are performed to validate the accuracy of the data; and partner with internal and external parties to successfully load files in required analytical platforms, including but not limited to Milliman, Epic, and Coreo.
• Supports Managed Care Contracting, Managed Care Finance, regional Finance departments, and ACO leadership with routine reporting and analytics of value-based contract performance in financial and quality measures. Analytics will also identify areas of opportunity for improvement. Coordinate reporting and analytics with SSM’s value-based partner, Navvis.
• Support contracting efforts for new and renewing value-based arrangements through review of contract language proposals, review of payer modeling, analysis against prior performance, and building forecasting models using EMR and payer claims data.
• Facilitate organizational decision making regarding the purchase of reinsurance through payers, independent reinsurers, or self-insurance.  Where reinsurance is purchased, monitor for appropriate recovery of claims.
• Audit payer data as appropriate including, but not limited to: auditing payer attribution against an organization standard; reconciling payer quarterly and final settlement against payer provided member and claims information; and periodic request/review of payer SOX audit reports.
• Manages staff which includes recruitment, orientation, training, performance management, as well as the development of staff. Responsible for management functions including activities related to staffing such as recruitment, hiring, and performance evaluation. Provides support and acts as a mentor while providing guidance to ensure their success.
• Performs other duties as assigned.

EDUCATION

• Master’s degree or equivalent combination of education and experience

EXPERIENCE

• Ten years experience, with five years in health care

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.