SSM Health — a nationally recognized Catholic, not-for-profit integrated health system serving Illinois, Missouri, Oklahoma, and Wisconsin is seeking a Director - Medical Analytics.
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Delivers insights and create analytics capabilities that will enable the organization to succeed in value-based contracting. Develops analytics strategies and financial models in collaboration with vendor partner that support organizational data-driven decision making in value based contracting. Delivers insights into the performance of value-based contracts, drivers of that performance, and identifies actionable opportunities for improvement to leadership, clinical operations and managed care contracting. Evaluates contract proposals to support managed care contracting efforts. Obtains and validates payer reporting, verifies contract payments, and makes recommendations on reinsurance decisions.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES:
Facilitates the acquisition of value-based payer information and data files (claims, eligibility, financial reports, physician rosters, etc.); ensure all necessary quality assurance activities are performed to validate the accuracy of the data; and partner with internal and external parties to successfully load files in required analytical platforms, including but not limited to Milliman, Epic, and Coreo.
Supports Managed Care Contracting, Managed Care Finance, regional Finance departments, and ACO leadership with routine reporting and analytics of value-based contract performance in financial and quality measures. Analytics will also identify areas of opportunity for improvement. Coordinate reporting and analytics with SSM’s value-based partner, Navvis.
Support contracting efforts for new and renewing value-based arrangements through review of contract language proposals, review of payer modeling, analysis against prior performance, and building forecasting models using EMR and payer claims data.
Facilitate organizational decision making regarding the purchase of reinsurance through payers, independent reinsurers, or self-insurance. Where reinsurance is purchased, monitor for appropriate recovery of claims.
Audit payer data as appropriate including, but not limited to: auditing payer attribution against an organization standard; reconciling payer quarterly and final settlement against payer provided member and claims information; and periodic request/review of payer SOX audit reports.
Manages staff which includes recruitment, orientation, training, performance management, as well as the development of staff. Responsible for management functions including activities related to staffing such as recruitment, hiring, and performance evaluation. Provides support and acts as a mentor while providing guidance to ensure their success.
Performs other duties as assigned.
EDUCATION
Master’s degree or equivalent combination of education and experience
EXPERIENCE
Ten years experience, with five years in health care
PHYSICAL REQUIREMENTS
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Rare climbing.
Department:
8764080033 System Value Based Contract Analytics
Work Shift:
Day Shift (United States of America)
Scheduled Weekly Hours:
40
SSM Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.
