Managed Care Provider Relations Manager jobs in Nashville, TN

ScionHealth is recruiting for a Director of Managed Care Analytics to join our team! 

Job Summary

The Director of Managed Care Analytics is responsible for supporting the Vice President Managed Care as well as the Managed Care Contracting team in contract modeling, strategic planning, budgeting, financial analysis, and evaluating potential acquisitions.  This role supports managed care, hospital  operations, and physician operations across the ScionHealth enterprise by providing analysis managed care financial metrics, including but not limited to volume trends, contract yield, financial performance analysis, benchmarking, and trend analyses to support strategic pricing.

Primary Responsibilities

• Responsible for reporting and analytical functions, including operating as the “business owner” of all Managed Care systems and software.
• Lead, direct, and support analytical needs of the Department and across the ScionHealth enterprise.
• Work closely with the Vice President Managed Care, Managed Care department, Operating leaders at every organizational level, as well as other Support Center functions to provide insightful data and meaningful analysis to support the organization’s Managed Care goals and objectives.
• Work closely with IT, finance, revenue cycle managers, Case Management at Support Center and Divisional levels to optimize the net revenue yield on all Managed Care contracts.
• Conduct financial performance analysis of the Managed Care contract portfolio both at an individual payor/contract level as well as more broadly across payor segments.
• Analyze complex information and reports to provide accurate in-depth analysis and timely recommendations to Managed Care and operational leaders for decision-making in both written and oral presentations.
• Implement and work with business intelligence tools and dashboard reports.
• Responsible for all managed care financial modeling tools to guide negotiations and facilitate strategic pricing.
• Accumulates, analyzes, and reports to management complete information regarding results of managed care contracts.
• Stays abreast of trends and developments in the Managed Care industry.

 Knowledge/Skills/Abilities

• High degree of proficiency with MS Excel and/or MS Access.  Ability to create and maintain complex spreadsheets and/or interrelated spreadsheets, using advanced functions, macros, and pivot tables.
• Familiar with relational database structures and ability to use SQL and other query tools to access data directly from tables without programmer support.  Experience with Business Objects and SAP products desired.
• Understanding of medical coding systems affecting the adjudication of patient accounts in EDI or UB04 form.  These include ICD-9, CPT, HCPCS, DRG, APG, APC, and revenue code structures.
• Advanced financial analytical skills.
• Proficient computer skills.
• Ability to analyze and interpret data.
• Managerial skills.
• Strong interpersonal, communication, and organizational skills.
• Knowledge of information systems.
• Knowledge of industry reimbursement methodologies.
• Approximate percent of time required to travel:  10%

Education

Bachelor's degree in Business Administration, Accounting, Finance, or commensurate experience in Health Care or Managed Care industry.

Licensure/Certification

Project Management certification preferred, but not required.

Experience

8-10 years of progressive experience in financial and data analysis in the Healthcare industry.

*Depending on a candidate's qualifications, role may be filled at a different level.