Let's face it, you've always known that healthcare is far more than just a job--it's a calling. Isn't it time that you joined a healthcare organization that feels the same way? Spartanburg Regional Health System may be just what you've been looking for! A culture based on collaboration and empowerment! You name it, we've got it and you can be part of something larger than yourself.
As a part of the heart and soul of our healthcare organization, we've got you covered on compensation, with fantastic pay and the best coverage for you and your family, including:
We'll also reward your hard work with:
Re-Location Incentive Bonus (for those who qualify)
Health, Dental, and Vision Plans
Prescription Drug Plan and Employee Pharmacy
CarePlus Disease Management, Employee Wellness, Rapid Weight Loss, Tobacco and Nicotine Cessation, Child Development, and Pampered Pregnancy Programs
Flexible Spending Accounts for Dependent Care and Medical
Credit Union Services
Life insurance w/AD&D
Free On-Site Parking
401k Tax-deferred Savings Plan and 401k Roth Savings Plan with Company Matching Dollars
Paid Time Off
Discount and Purchase Programs
Reward and Recognition Program
SRHS Payor Strategy and Relations negotiates and maintains approximately $1B annual operating revenue from Commercial, Medicare Advantage, and Managed Medicaid contracts on behalf of all SHRS and RHP providers. Payor Strategy and Relations is responsible for the development of pricing strategy for all SRHS providers and collaborates with South Eastern Health Partners (SEHP) and Regional Health Plus (RHP) teams to lead the transition to value based care. Value based care encompasses but is not limited to risk-based contracting, performance and quality program design as well as episode development and associated gain sharing.
Payor Strategy and Relations responsibilities are constantly evolving and currently represent key components of SRHS's strategic imperatives. The department is responsible for both payer relationship management and pricing strategy and analytics. The Manager of Payor Analytics position is responsible for providing support for negotiation of SRHS, SEHP, and RHP Payor contracts and supporting the Population Health initiatives of SRHS.
The Manager of Payor Analytics must have strong analytical skills, good organization and communication skills, and the ability to manage multiple projects to meet aggressive deadlines. He/she will possess a strong intellectual curiosity and desire to learn and tackle new issues daily. The initiative to take ownership of projects and think about the impact of each decision on all organization operations is also a crucial trait for this position.
Payor Strategy Support
Work closely with VP of Payor Strategy, SVP of Population Health to develop and update SRHS's Payor Strategy based on market changes and new opportunities
Work closely with other SHRS corporate functions, including but not limited to Marketing, Finance, Revenue Cycle, Quality Management to provide sound strategic and tactical recommendations for various SRHS initiatives
Identify and recommend revenue or market share growth opportunities through changes in pricing strategy or new pricing tactics.
Research pricing trends and recommend new approaches for SHRS such as price transparency, changes in price elasticity, trends in deductibles/co-insurance, new payment models, and value based pricing.
Develop thorough knowledge of the commercial payer community including M&A and performance research.
Payor contract Negotiation Support
Lead all analyses and financial impact projections of existing and proposed contracts and performance programs between SHRS, SEHP, RHP and Payor organizations. Present findings and make proposal recommendations during negotiation process.
Build analytical models to evaluate financial impact of various other pricing initiatives.
Responsible for design and production of contract models to support payor negotiations.
Sophisticated models include hospital, physician, home health, SNF, LTAC and outpatient surgery centers.
Ability to distill data to salient information and recommendations and present findings of all analyses in a logical, concise manner and format required.
Modeling will require expert knowledge of commercial reimbursement, Medicaid reimbursement and Medicare reimbursement models.
Provide recommendation regarding reimbursement elements to improve overall contract yield to SRHS and SEHP and RHP providers
Work with VP of Payor Strategy and VP of Revenue Cycle on processes and recommendation for annual charge master increases
Develop and maintain tools to monitor SRHS, SEHP and RHP performance in quality programs and estimate financial impact.
Population Health Financial Modeling
Responsible for SEHP and RHP risk pool and bonus pool database management and reporting.
Responsible for monitoring and reporting Patient Care Medical Home payments from contracted Payors
Provides input and recommendation to SVP of Population Health and VP of Payor Strategy regarding Population Health models, risk pool distribution models to support various SEHP and RHP Committees.
Model value of performance program elements from a market perspective to inform development and enhancement of programs.
Population Health Operations Support
Act and primary liaison with Payors for all matters related to financial, utilization, and quality reporting.
Responsible for insuring Payor databases are updated and accurate for use by SRHS and RHP staff.
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.
Data Base Management
Manage Deerwalk relationship.
Utilize internal data systems (Trendstar, Epic, Strata, Deerwalk etc) and external data to drive analyses as required. Reconcile and verify data to ensure data integrity and reasonableness.
Manage and streamline process for securing and maintaining data from Payors in SRHS designated databases and software, (currently Deerwalk), to support current RHP Withhold Process and other analytics as required for Payor Strategy and Relations and Population Health Departments
Insure all databases are up to date, accurate and complete.
Develop expertise of data bases and insure staff are trained on data bases available from Payors in support of Population Health contracts including but not limited to
Aetna - TBD
BCBS – TBD
CIGNA – E-Commerce
CIGNA HealthSpring – Lumeris
Humana – Carebook and Service Fund
United Healthcare - TBD
Wellcare - TBD
Design and develop monthly Payor Strategy and Population Health reports, including dashboards, financial and utilization trends for SRHS, SEHP and RHP providers
Produce reports for Payor Strategy Council, RHP Contract Committee, RHP Population Health Committee utilizing Payor Strategy Databases and reports / data provided by Payors as directed by VP of Payor Strategy or SVP Population Health.
Payor Data Sharing
Provides input into SRHS's Payor Data Sharing Strategy in support of Payor and Population Health Contracts
Responsible for management and implementation of SHRS's Payor Data Sharing strategy.
Work with SHRS Data Governance Committee members to provide data from SRHS EMR and other data systems as required by Payor Contracts.
RHP Withhold Process
Work with Vice President of Payor Strategy and Executive Director of RHP in refinement and redesign of RHP withhold process utilizing payor data in Deerwalk or other database as determined to improve efficiency and provider satisfaction. Implement agreed upon process insuring accuracy, completeness and timeliness of invoicing and collection of withholds to providers
Work with SRHS Finance and RHP Executive Director in production and distribution of invoices to RHP providers.
Work with SRHS Finance to properly account for RHP Withhold Process.
Committee Participation and Support
Participate in and provide financial reports to SRHS Payor Strategy Council as required by Vice President of Payor Strategy
Participate in and provide financial reports to SEHP Contracting, Population Health, and Future Payor Contracting Committees and other SEHP committees as required as required by Vice President of Payor Strategy and Relations.
Participate in and provide financial reports to RHP Contracting and Population Health Committees and other RHP committees as required as required by Vice President of Payor Strategy and Relations.
Payor Engagement Meetings
Support VP of Payer Strategy and Relations as needed in resolution of ongoing service issues with payers.
Participate, review and provide financial analysis reports to Payor Engagement meetings including Joint Operating Committee, Quality and Gap Closure, Service Fund Performance, and other meetings as directed by Vice President of Payor Strategy
Team Support and Development
Proactively support departmental and organizational vision, strategic imperatives, and policies and procedures.
Develop a strong team player environment, prompt open effective communication, and constructively resolve internal and external conflicts.
Minimum requirement – BS in Finance/Accounting or business or healthcare related field.
5 years' experience in hospital or managed care financial analysis role.
Excellent analytical skills and ability to manipulate large data sets from multiple systems using MS Office, SQL, SAS, or other database management tool.
Familiarity with EPIC, Trendstar, and Strata contract management system is preferred.
Familiarity with current common coding practices including CPT4, ICD9CM, and DRGs as well as current Medicare reimbursement methodologies.
Knowledge of pricing, healthcare finance, managed care, provider incentives, and risk contracting required.
Understanding of healthcare expense risk for populations, its components (unit price and frequency), and drivers.
Internal Number: 4901
About Spartanburg Regional Healthcare System
Spartanburg Regional Healthcare System is an integrated healthcare delivery system that provides care from birth to hospice. We meet you where you are with things that make a difference in your life. We've been your partner for more than 90 years, and have earned a reputation for technological excellence throughout the Southeast. With over 6500 employees, we provide the highest quality of care to patients in Spartanburg, Cherokee and Union counties in South Carolina, and Polk and Rutherford counties in North Carolina.