Manager Provider Analytics - 003802

Company: Univera Healthcare
Location: Utica
Posted on: June 4, 2021

Job Description:

Summary

The Manager Provider Analytics oversees analytical support to the contracting, cost savings, quality and financial strategies which include physician and ancillary providers. The position is also accountable for timely and quality implementation of physician and ancillary rates including requirements, oversight and production validation.

This position includes collaborating with the Directors within contracting, pharmacy, finance, IT, the quality office and Medical services to support the negotiation process, reimbursement model development, tracking financial status of negotiations with respect to the budget and rate filings, network reporting and development, reimbursement rate configuration/production validation and contracting functions.

Essential Responsibilities/Accountabilities

• Leads provider analytic operations and staff through the development, implementation, and maintenance of credible and affordable mechanisms to analyze internal and external provider cost/quality metrics. Creates and maintains technical solutions for data warehousing and analysis, participates in the identification of data requirements and specifications, determines actions to be taken, manages workload to assure customer requirements are fulfilled in a timely manner and with quality controls to meet analytic requirements.
• Assigns staff to work on high level special/priority projects, presentations, and ad-hoc provider analytic requests as requested by management. Examples include, but are not limited to, developing templates and models for annual contracting processes and provider analytic support related to performance improvement programs.
• Assesses current tools and training required for all analytical staff, makes recommendations for which tools should be used to automate, and supports analytic functions on all teams. Develops training programs as necessary. Accountable for assessment and acquisition of potential tools/software to add efficiencies to processes, procedures, and activities.
• Oversees contracting and network data sources for use in provider negotiations, contract development, network development, training, and analysis. This includes oversight of data manipulation, integrity and input, balancing results with actuarial and financial departments. Provides multiyear, cross regional information with respect to price and network management of all products and competitor information, benchmark measurements, and reporting and access to information through development and maintenance of user friendly, real time menu driven software tools.
• Develops decision support modeling tools and leads the design, development, ongoing maintenance and related improvement of internal databases to assure meaningful relevant data, ease of use and analysis, timely availability of information, and optimum accuracy. Develops and maintains access to performance improvement information and databases for the ongoing analysis of cost/quality information and identification of national benchmarks and trends in Plan network performance. Determines what data is needed and appropriate for data modeling and provider analysis. Determines overlaps and coordinates effort to increase staff knowledge. Maintains templates and processes for all provider analytics and activities.
• Works with various departments and external vendors as necessary to combine claims history, provider cost report information, utilization information, and competitor information into a common contracting database. Assesses all available external and internal source options for access to required data elements and resulting costs and implications of acquisition, including cost benefit analyses and implementation of work plans.
• Provides expertise to Contracting and Network services areas in rate modeling and fee schedule preparation, training, process development, etc. Identifies and recommends process improvement strategies for interfaces with provider negotiations, provider relations, operations, and other appropriate departments.
• Collaborates with the appropriate Health Care and Network Management (HCNM) leadership to develop, implement, and maintain provider data requirements to support the Health Plan's overarching quality plan and network strategies. Oversees the detail data requirements, monitors and ensures timeframes are met, and modifies requirements as needed to reflect market changes.
• Conducts in-depth provider cost/quality analysis and ongoing assessment to identify opportunities for improvement and provides information for the annual evaluation. Assures statistical validity and reliability in measuring cost/quality performance improvement across providers. Collaborates extensively with the Medical Directors and contracting staff to identify meaningful performance metrics and provider-specific analytics as required.
• Supports strategy discussions with analytic to explore the intersection of cost and quality analytics across the Plan's provider network and potentially enhance current reporting. Maintains current understanding of national approaches to performance improvement and measurement, such as value-based purchasing and alternative payment methodologies, and explore related system requirements. Makes appropriate recommendations to assure state-of-the-art development.
• Leads provider analytics surrounding current/future payment models and other analyses as requested in a health reform environment, to include global payment arrangements associated with Accountable Care Organization development, bundled/episode based payments and related Episode Treatment Group (ETG) analyses.
• Determines the performance measures, associated benchmarks, and other content to include on the hospital network profile. Assures reliability of measures and statistical methodologies in tracking performance and related outcomes. Coordinates ongoing maintenance and development of the hospital network profile to assure state-of-the-art in profiling. Initiates, coordinates, and prepares profiling of hospital network performance.
• Participates in the development and testing of a primary care/specialty physician profile and leads provider profiling analytics to include ongoing validation of provider crosswalk and attribution results, contributes to the development and maintenance of a Plan-wide attribution standard/policy, assesses cost/quality variations in provider performance, and identifies strategies to improve data quality overtime.
• Exhibits and maintains a high degree of knowledge relative to physician identifier schemas, internal physician measurement capabilities and related limitations, and leads the development of enhanced provider analysis/profiling strategies.
• Oversees research of business and system requirements to deliver local payment innovations and network arrangements. Oversees research and collaborates with other Health Plans, consultants, providers, and other health care entities to identify availability and use of performance improvement activities, performance incentive program enhancements, hospital and physician profiling development, and related benchmarks.
• Oversees analysis and presentation of provider data from performance monitoring activities. Prepares reports, graphically displays data, and identifies outliers to share with senior management, key network leaders, hospital CEOs, Chief Medical Officers (CMOs) and CFOs, and committee and Board presentations. Participates in external network meetings and committees and Boards to present information as needed.
• Monitors reimbursement methodologies for all lines of business. Translates reimbursement strategies of government agencies into health plan requirements.
• Develops reimbursement configuration requirements for physician and ancillary providers utilizing internal and external data sources.
• Facilitates the process for implementing physician and ancillary rates including production validation.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications

• Bachelor's degree in Healthcare Field, Information Technology, Business Administration, Finance, or similar area with a minimum of five years business experience including modeling, financial analysis, and/or provider analysis. In lieu of degree, a minimum of seven years of business experience including modeling, financial analysis, and/or provider analysis. Masters degree preferred.
• Minimum of three years in a supervisory/management capacity.
• Must have reimbursement background and some degree of physician compensation expertise.
• Prior training experience.
• Excellent written and verbal communication skills required.
• Must be able to manage multiple projects concurrently.
• Must have strong project management experience and be highly organized.
• Experience in database and software development required. Is proficient in databases and tools utilized for both internal and external performance monitoring.
• Previous experience in health related field required.

Physical Requirements

The Lifetime Healthcare Companies aim to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Keywords: Univera Healthcare, Utica , Manager Provider Analytics - 003802, Other , Utica, New York