Overview
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities
Job Summary / Purpose
The System Manager, Payment Transformation leads the accounting and performance analysis activities for value-based agreements (VBA) and initiatives. Develops, recommends and assists with implementing strategies for maximizing reimbursement and market share from value-based programs and payment models. Monitors VBA participation and performance across the system using standardized tracking and reporting tools. Develops new value-based initiatives with payers that are consistent with established strategic priorities. Provides education to key stakeholders.
This position will serve and support all stakeholders through ongoing educational and problem-solving support of value-based arrangements.
Essential Key Job Responsibilities
- Manage the labor and operations of the Payment Transformation team including the hiring, orienting, developing and managing of staff.
- Prepare and effectively present VBA analysis results to senior leadership, and other key stakeholders, for review and decision-making.
- Act as the Payer Strategy & Relationships leader liaison to leadership across CommonSpirit Health for tracking, reporting, updating and communicating VBA participation and performance information.
- Develop and approve financial models for value-based agreements (VBAs) using SQL and Excel.
- Analyze and publish VBA performance statements and determine profitability. Drive strategies and solutions in order to maximize VBA reimbursement and market share, which have multi-million or multi-billion-dollar impact to CommonSpirit Health. Review and accurately interpret VBA contract terms, including development of policies and procedures in support of value-based arrangement negotiations.
- Provide training and oversight of the modeling of proposed/existing VBAs negotiated by payer strategy and relationships, including expected and actual revenues/volumes, population risk calculations, past performance, proposed contract language and regulatory changes.
- Oversee the preparation of risk-share/gain-share funds flow models and financial distribution reports of VBA payments and repayments.
- Create and/or manipulate data utilizing queries and scripts to mine and manipulate existing data in support of application test efforts. Works with Business Analysts, application teams, and Testers to analyze data requirements to support all phases of testing. Creates and maintains documentation and descriptors for data elements / attributes, and other required forms of metadata.
- Oversee the identification, collection, and manipulation of data from a wide variety of financial and clinical internal databases and external sources (e.g., Medicare/Medicaid website). Identify and access appropriate date resources to support analyses and recommendations. Identify risk/exposure associated with various VBA reimbursement structure options. Oversee the production of analytical statistical reports on new ventures, products, services, being considered. Perform sensitivity analyses on operating and underlying assumptions such as modification s of charges rates.
The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.
**prevailing wage for the position is $127,005
Qualifications
- Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare or related field. Equivalent education and experience may be considered in lieu of degree
- Minimum of three (3) years leadership experience
- Minimum of five (5) years of experience in Healthcare, insurance or related industry experience
- Must be proficient in reading, interpreting, and formulating complex computer system programming/rules
- Intermediate level working knowledge of SQL and Excel
- Working knowledge of Google Suite products
- Intermediate knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation
- Must be able to lead and coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines
- Must have working knowledge of healthcare financial statements or accounting principles
- Ability to use and create data reports from health information systems, database, or national payer websites
- Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas