Experience Inc. Jobs

Description

Summary:

Network wide role is responsible for developing and implementing contract reimbursement models and data reporting in support of the payer contracting initiatives and network operations.

Responsibilities:

1. Responsible for all commercial payer contracting modeling for Nuvance Health entities (hospitals, medical groups and ancillaries) as well as WCHN PHO utilizing financial and cost accounting systems in support of the contract negotiation process. Creates post signing revenue projections and assists in loading the contract financial terms into Contract Management and Cerner billing systems.* *

2. Leads effort to design ACO, PHO, PCMH data collection and financial reporting to enable Nuvance to accept full risk contracting and support patient population management efforts. Includes, but is not limited to, monitoring of performance metrics using multiple data sources. Assists in developing Bundled Payment methodologies and recommended payment splits; shared savings and joint contracting analytics.* *

3. Builds performance improvement reporting architecture - data based mechanisms and processes to monitor and manage utilization of health care services within value based contracting Works collaboratively with IT and CMIO to develop contractual models to measure care across the continuum. Supports PHO transition to clinical integration by developing standardized and ad hoc reports.

4. Makes data based recommendations on rates for the negotiating team. Generates and disseminates highly confidential data applicable to payer contracting efforts for all affiliates of Nuvance Health.

5. Leads managed care efforts and collaborates with internal and external key stakeholder in the implementation of new reporting/modeling systems by assisting in the data loading, designing contract models, developing and interpreting reports and loads reimbursement rates. Participates in ongoing support of the new system and the integrity of the data. Is a member of the newly formed "transition team" converting L-legacy financial systems into a single Nuvance health finance platform.

6. Maintains and Models Nuvance Health values

7. Performs other duties as required

Other Information:

Ability to handle highly complex analytics; understand payer contracts and detailed reimbursement structures. Familiarity with accounting terms and their application. Critical thinking in support of data analysis, data collection and aggregation and alternate data display. In depth knowledge of coding and compliance; strong familiarity with coding, billing and reimbursement.

Experience with EPSi, Cerner, Soarian Financials, Excel, Access

Working Conditions:

Manual: Some manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Nuvance Health

Org Unit: 1783

Department: Managed Care

Exempt: Yes

Salary Range: $57.22 - $106.26 Hourly

We are an equal opportunity employer

Qualified applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other classification protected under applicable Federal, State or Local law.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation or our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to ensure that you are considered for current or future opportunities.