Manager - Managed Care Reporting & Analytics

The Manager - Managed Care Reporting & Analytics is responsible for leading a team of analysts that support the organization's managed care contracting activities. These functions include analyzing and interpreting data related to managed care contracts, monitoring payer performance, and ensuring appropriate reimbursement based on contractual agreements. The role involves developing strategies to optimize payer relationships, improve reimbursement rates, and ensure compliance with regulatory requirements. The position requires a strong background in healthcare analytics, excellent leadership skills, and a deep understanding of managed care principles.

Responsibilities

• Analyzes payer performance data to identify trends, opportunities, and areas for revenue improvement.
• Conducts market research to stay informed about payer industry trends and policies.
• Develops and maintains payer dashboards and reports to track key performance indicators (KPIs) by payer.
• Provides actionable insights to senior management based on data analysis.
• Monitors contract compliance and addresses any issues or discrepancies in reimbursement such as denials and underpayments.
• Implements processes to ensure adherence to payer contract regulatory requirements.
• Fosters a collaborative and innovative team environment, focused on new ideas and productive outcomes.
• Maintains responsibility for department’s operational excellence; ensures department delivers quality services in accordance with applicable policies, procedures, and professional standards.
• Manages team members, which includes orientation, development and evaluation of team members, and monitoring the provision of delivering quality services. Participates in the recruiting, interviewing, and selecting of team members following policies, guidelines and applicable laws. Evaluates team member’s performance relative to job goals and requirements. Provides coaching to staff, recommends education programs, and ensures adherence to internal policies and standards.
• Maintains responsibility for the fiscal management of department and assures proper utilization of organization’s financial resources.
• Effectively communicates departmental, organization, and industry information to staff.

Qualifications

Minimum Education

• Bachelor's Degree Business, Finance, Health Care Administration, Related field Required
• Master's Degree Business, Finance, Health Care Administration, Related field Preferred

Minimum Work Experience

• 5 years Finance, Managed Care, or Revenue Cycle Analyst experience. Required
• 1 year Leadership experience. Preferred

Required Skills, Knowledge and Abilities

• Strong analytical and problem-solving skills.
• Ability to build relationships at all levels of the organization.
• Ability to use critical thinking skills and plan strategically and to deliver at a tactical level including driving organizational transformation.
• Strong intuition and ability to dig deep into data, using tools such as Power BI and Optum Payment Integrity Compliance.
• Ability to demonstrate a wide spectrum of analytics skills, data management skills, data science methods, and industry best practices including predictive and prescriptive modeling to deliver information to drive improvement in outcomes.
• Familiarity with value-based payment models.