Director Managed Care Contract Analysis

Job Title & Specialty Area: Director Managed Care Contract Analysis Department: Managed Care Location: Dallas, TX Shift: Monday thru Friday 8:00 a.m. to 5:00 p.m. Job Type: Remote Why Children’s Health? At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal. Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well-being. Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all. Summary: Oversee the Managed Care hospital and professional billing analytics including financial interpretation of contracts terms, contract modeling, financial analyses, EPIC contract build, audit and maintenance and identification of revenue enhancing opportunities. Develop alternative financial proposals that are within the budget parameters, based on analysis and modeling of contract performance by developing and preparing revised models using sound rationale, and present recommendations and executive summaries to Managed Care leadership. Support the organization by providing ad-hoc detailed data reports related to Managed Care agreements and Patient Financial Services activity to internal and external customers. This role will develop and implement business workflows, plans, policies, and procedures. Collaborates with other departments to prioritize and ensure Managed Care contract performance and all related analytic needs are met for the system. Evaluate results within business unit to determine if organizational objectives are being met.Provider oversight to the collecting and analyzing data to identify opportunities to partner and improve processes and outcomes. Evaluate information, prepare recommendations to help make fact-based decisions and promote optimal quality care processes. Evaluate recommendations about data collection and management methodology to better support quality reporting goals and present to executives. Manages a team of financial and quality analysts and ensure they are trained and have needed resources. Responsibilities:

• Complete financial impact analysis of hospital and professional contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. Present analysis and recommendations to leadership.
• Prepare multiple analyses and presentations by extracting data from systems including; Crystal, EPIC, STRATA and other Children's Health Services of Texas (CHST) systems and relational databases utilizing strong expertise in Excel. Evaluates the need to create new or modify existing ad hoc and/or customized reports.
• Analyze contracts and prepare all supporting schedules necessary to update/maintain the EPIC system on a current basis. This includes but not limited to: reviewing all new contracts/amendments, meeting with Patient Financial Services staff to review changes, communicating with the payors to receive all updates on current basis, researching and downloading data form payor sites, analyzing and comparing new fee schedules to the prior fee schedules, preparing all uploads, validating input and updating EPIC reimbursement contracts. Audit all Managed Care contracts and amendments as received to ensure that all contracts in EPIC are current and calculating correctly.
• Stay abreast of and communicate all Texas Medicaid & Healthcare Partnership (TMHP) regulation changes that affect Fee Schedule pricing. Proactively model all changes to fee schedules to determine the financial impact on CHST revenue and communicate with leadership.
• Oversee the administration programming and analysis of EPIC Contract Management applications critical to business and l operations.

How You’ll Be Successful: WORK EXPERIENCE

• At least 7 years experience in financial analysis, data mining and reporting required.
• At least 5 years experience in Healthcare, Contract Modeling for facility and professional agreements required.
• At least 7 years experience in electronic health record, hospital billing systems, complex databases, statistical analysis required.
• At least 5 years management experience required.

EDUCATION

• Four-year Bachelor's degree or equivalent experience required.
• Graduate or professional work or advanced degree; or equivalent experience preferred.

LICENSES AND CERTIFICATIONS

• EPIC certification for Hospital and Professional Billing (Contract Management) 1 Year required.

A Place Where You Belong We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children’s Health a place where everyone can contribute. Holistic Benefits – How We’ll Care for You:

• Employee portion of medical plan premiums are covered after 3 years.
• 4%-10% employee savings plan match based on tenure
• Paid Parental Leave (up to 12 weeks)
• Caregiver Leave
• Adoption and surrogacy reimbursement

As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity. Apply tot his job Apply To this Job