Job Summary:
The Manager, Provider Contracting Analytics is responsible for the day to day operations of the Provider Contracting Analytics area focusing on providing analysis and modeling regarding health partner contracts.
Essential Functions:
- Executes the strategic direction for team
- Ensure the Contracting Analytics function proactively collaborates with and provides support for analyses being conducted by areas outside the department
- Investigates opportunities for contracting improvements with existing partners and identifies areas for network optimization. Identifies issues related to reimbursement and recommends appropriate solutions
- Identify and translate into action plans industry best practices for contracting, including contract structure, modeling, and reporting
- Actively participate in operational calls with key providers or network partners as needed
- Develops and provides actionable recommendations to senior management relative to all analysis and/or ad hoc reporting
- Track and report historical results of network optimizations
- Ensure all governing body regulations are adhered to at all times for existing and future lines of business
- Support the budgeting and forecasting processes
- Build and strengthen provider relationships by facilitating quality service
- Ensure integrity of information obtained for analysis; keep up-to-date knowledge of the technical systems, claims processing initiatives, and CareSource payment policies
- Provide guidance and mentorship to analysts
- Perform any other job duties as requested
Education and Experience:
- Bachelor of Science/Arts Degree in accounting, finance, economics, computer sciences or related field or equivalent work experience is required
- Masters or other advance degree in related field is preferred
- Minimum five (5) years of professional level experience performing a broad range of data analysis required, preferably in healthcare contracting and/or financial field
- Prior management experience preferred
- Experience communicating and presenting to senior leadership preferred
- Provider contracting experience is preferred
- Managed care or healthcare experience is preferred
Competencies, Knowledge and Skills:
- Advanced proficiency with Microsoft Suite to include Word, Power Point and Outlook
- Expert proficiency with Microsoft Excel
- Intermediate knowledge of SQL, SAS, R or other statistical software
- Knowledge of health care reporting standards
- Ability to work independently and to manage multiple priorities with limited resources
- Ability to effectively report data, analyze facts, and exercise sound business judgement when making recommendations
- Ability to analyze problems, draw conclusions, develop processes and communicate status and results
- Excellent oral and written communication skills
- Ability to interact with executive levels of management as well as external stakeholders
- Auditing skills
- Strong interpersonal, leadership and relationship building skills and high level of professionalism
- Ability to lead and direct the work of others including the development motivation and rewarding of staff
Licensure and Certification:
- None
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$90,500.00 - $158,400.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
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Create an Inclusive Environment
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Cultivate Partnerships
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Develop Self and Others
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Drive Execution
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Influence Others
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Pursue Personal Excellence
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Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
Top Skills
What We Do
Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for nearly 30 years and we will continue to be a transformative force in the industry by placing people over profits.
CareSource is and will always be members first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to nearly 2 million members through plan offerings including Marketplace, Medicare Advantage and Medicaid. With our team of 4,000 employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve.
CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law. If you’d like more information about your EEO rights as an applicant under the law, please click here: https://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf and here: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf
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