Director Performance Management/ Government Programs Analytics—Health System-Southeast

Job Summary

 

This newly-created role will serve as the expert resource in the areas of Medicare and Medicaid reimbursement. This position will be responsible for providing guidance and strategic recommendations on reimbursement methodology and rates for Medicare and Medicaid based reimbursement.  This Director has a very good understanding of current Medicare and Medicare regulations and reimbursement methodologies and has oversight of analytics related to Medicare and Medicaid regulations and reimbursement terms. Systematically plans and executes medium and long range activities to prepare for future contracting events. Responds to extremely urgent, mission-critical projects driven by contracting opportunities or issues. Responsibilities span all System owned, leased or managed entities.

 

Essential Functions

 

• Is the resident expert on Medicare and Medicaid regulations, policies and reimbursement.
• Is able to communicate any changes in regulations or reimbursement methodologies across the System.
• Provides accurate and timely information, while providing strategic and comprehensive guidance to the Managed Care leadership in support of contract negotiations and other initiatives.
• Ensures that any analytics or financial analysis performed is consistent with the latest Government regulations and reimbursement methodologies.
• Is able to apply Government regulations, policies and reimbursement methodologies in support of Medicare Advantage and Managed Medicaid contract negotiations.
• Manages multiple, complex projects using all available resources, while exercising good judgment toward meeting goals and objectives.
• Understands and complies with HIPAA requirements for PHI security and disclosure.
• Maintains knowledge of trends and developments in the field via journals and related materials, attending seminars, conferences and vendor training sessions.
• Reviews and documents completed reports/projects and establishes review and QA processes to ensure accuracy in modeling and analysis.
• Collaborates with infrastructure teams to determine appropriate data sources and data needed to support related managed care analytics.

 

 

Education, Experience and Certifications

 

Master’s Degree required; MBA OR MHA preferred. Minimum of 5 years in health care finance, planning or managed care analytics experience in provider or MCO setting is required. Must possess strong knowledge and understanding of government-based reimbursement and regulations. Must be proficient with large sets of data and be able to provide concise, clear deliverables for executive level use. Expertise with personal computers and Microsoft Office Professional software required. Expertise with decision support and database tools such as HPM/HBI, Access, SQL Server and Crystal Reports preferred.

 

Consultants—The French Group

 

For additional information and/or confidential consideration, please contact Tricia French, RN, BSN at tfrench@frenchgroup.com or 757-362-0202.