Recruit, prepare, educate, train and support staff in the preparation of the data analysis for provider network cost of care activities encompassing Capital’s total book of business and subpopulations at the various defined market segment, regional, and provider specific levels to examine utilization and cost trends; reporting and data analysis for medical value and value-based provider contracting to support the provider contract negotiations, monitoring and settlements. Ensure that timely and accurate information is available for the Healthcare Delivery and Provider Partnerships leadership and staff members considering relevant issues concerning data and the provider have been reviewed and addressed. Responsible for both independently completing and teaching, instructing and leading team members toward the successful delivery of the design, development and implementation of analysis and research on the cost and utilization trends relative to book of business, market segment, region, product, program, network, employer group, etc. and the communication of this information to key internal and external stakeholders. Ensures that rigorous research design, comprehensive data collection and sound statistical methods are applied to trends, forecasts, projections, corporate reporting, programs, and corporate projects. Provides Plan support for other analytical and reporting needs, trend analysis, financial improvement plan monitoring, compliance and regulatory reporting coordination. Individual will be independently responsible for a number of projects and also managing the team when performing retrospective trend analysis, prospective forecasts, business requirement gathering, customer needs assessments, documentation of data needs/source mapping, competitive and industry research. Participate, collaborate in and sometimes lead engagements with other business areas and customers, such as: external customers, providers, sales, marketing, population health management, utilization management, provider partnerships, actuarial, finance, and pharmacy services with a focus on being a subject matter expert providing technical and business level of involvement to support information needs in the analytical and decision-making process. Focused on projects collaborating with business areas or external customers where a proficiency in business knowledge exists. Assists business areas in the initial assessments, requirements, project plans, solutions, research and selections with a focus on data, information reporting, and analysis. Lead project task execution by ensuring progress, organizing project data, and coordinating team meetings. Provide information to customers/clients in development of engagements, materials, events, initiatives, committees, and presentations by gathering needed information and using appropriate frameworks and models in the development and assessment of materials. Create professional development, coaching, and performance improvement plans for staff to foster a positive culture and effective unit of skilled staff. Reinforces methods for customer service, information collection, documentation, and building customer satisfaction. Assist in developing an annual plan in support of the strategic vision and decision making for the department which considers available resources and anticipated workload. Periodically review and revise the plan recognizing changes necessary to address unanticipated demands or changes on the workload. The manager contributes and delivers information to communicate preferred solutions for consideration and recommended solutions. Serves on corporate committees, work groups, and teams as necessary to provide input and support on corporate initiatives.
Job Requirements:
Leadership:
Proven leadership skills related to managing, coaching, leading, motivating and innovating for process improvements to drive results to completion while managing multiple projects and priorities competing for resources. This includes performance appraisals as well as internally developed training programs and presentations on reimbursement and other provider network related topics.
Skills:
Demonstrated ability to analyze problems issues, outcomes, determine/estimate/project impact and provides or recommends business solutions.
Demonstrated strong oral, written and presentation skills.
Experience with Microsoft Office Suite products (Access, Excel, Word, PowerPoint, etc.), SAS, Tableau, PowerBi, or other software used for both analytic and reporting functions.
Knowledge:
- Extensive experience with population-based analysis, health care financial trend analysis, modeling, and a background in research methodologies and statistics.
- Strong knowledge of managed care insurance and business processes, data, systems, and applications for claim payments, network and provider contract administration and management, population management.
- Familiarity with regulatory changes impacting provider reimbursement and operations.
- Familiarity with current corporate structures for health care entities.
- Knowledge of the interrelationships of Capital operations (i.e. claims processing, rating, billing, account administration, sales, etc.)
- Strong knowledge of benefit coverage designs.
- Strong knowledge of operational aspects of various provider types
Experience:
Minimum of five - seven (5-7) years of experience with health services research, consulting, outcomes research, healthcare economics or epidemiology or within business/customer areas.
Education, Certification and Licenses:
Bachelor’s degree required in one of the following: mathematics, statistics, business administration, health planning and administration, finance, economics. In lieu of a bachelor’s degree, 10 years relevant experience required.
