Director, Payor Strategy & Analytics

PURPOSE AND SCOPE:

Supports the consolidation, analysis and reporting of commercial revenue.

Develops standards of review and analysis to facilitate accurate and timely analysis of all commercial revenue.  Identifies trends, variances, discrepancies, and issues and consults with management and executives to determine appropriate plan of action.

Supports Managed Care staff in budgeting and forecasting activities.

PRINCIPAL DUTIES AND RESPONSIBILITIES:  


* Participates in and communicates the FMCNA culture through customer service standards with billing groups, finance, IT, facilities and payers.


* Develops and maintains relationships through effective and timely communication with all.


* Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.


* Responsible for complying with all related FMCNA policies and procedures.


* Responsible for timely and accurate communication of revenue reporting to Managed Care Management Team.


* Responsible for compliance with all related data collections and auditing activities.


* Performs various national and global financial analyses to assist with contract proposals including determining project specifications and review methodologies.  Analyses will include review of claims data, analysis of medication utilization for global contracts and analysis of rate structure conversion.


* Consolidates patient insurance download data including developing standards for field review of data and reporting.


* Provides consolidated business / payer mix / revenue by payer / treatment mix on a monthly basis including developing departmental policies for data collection and reporting.


* Develops and produces analytical reports to support managed care efforts on a monthly or as needed basis.


* Coordination of requests for proposals including collection of data, evaluation of proposals and recommended course of action.


* Responsible for monthly review of P&L accounts to identify loss and marginal facilities tied to payer mix.


* Reviews billing accuracies to ensure that projected revenue is being realized.


* Maintains consolidated report which specifically lists and tracks all patients reimbursing according to commercial rates or single patient Letters of Agreement.


* Develops and maintains consolidated payer class revenue per treatment report and payer mix reports.


* Development and maintenance of contract and commercial patient database(s).


* Responsible for preparing and updating monthly consolidated revenue per treatment templates and charts.


* Performs quarterly analysis of network data for growth.


* Performs and maintains competitive insurance analysis of individual markets and competitive provider activity.


* Maintains database on health plan membership by product.


* Other duties as required.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The ph...