Job Information
Surgery Care Affiliates Director Payer Analytics in Remote, United States
Overview
Today, SCA Health has grown to 14,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.
As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge.
Responsibilities
SCAs Catalyst Analytics Team supports health plan, health system and physician alignment strategies alongside Payer Engagement, Strategy, Finance, and Development. The Analytics Team is comprised of dynamic individuals who support strategic initiatives through advanced claims data modeling and by developing market intelligence tools to help independent physicians – our primary customers – succeed in the years to come.
Job Overview:
SCA Health is currently seeking a Physician Practice Managed Care Analytics Director on the Catalyst Analytics team. We are seeking a candidate who is excited to take a thoughtful approach to examine and organize complex data for multiple physician specialty practices. Moreover, we are seeking an analyst with an investigative mindset to explore nuances of the data and use data to drive decisions through report preparation and analysis.
This position will be remote.
Responsibilities:
Mine data to discover key analytical insights for decision support, with a focus on evaluating and improving financial and operational performance on our physician provider contracts.
Understand and become an expert on the structure and intricacies of external data sources. Communicate with team members and collaborators to understand unfamiliar/ambiguous data, as well as explore data thoroughly.
Build models for physician provider contract negotiations including Medicare Advantage, Commercial Risk, Medicaid and Fee-for-Service
Thorough knowledge of Physician, ASC and HOPD Medicare fee schedules to be able to calculate and apply Medicare rates for benchmarking
Audit capitation report and review physician claims data to ensure the rates/payments are collected according to the health plan contracts. Understand and analyze monthly capitation payments made to network providers; identify and investigate unusual fluctuations and determine root cause of potential problems. Interpret risk pool arrangements and summarize risk pool and incentive
Analyze physician billing patterns to identify volume migration potential and cost of care savings related to hospital admissions, emergency room visits, ancillary services and referral patterns
Develop analytics infrastructure including reports and dashboards supporting physician practice operational and financial performance
Deliver actionable, supportable findings within tight deadlines and changing requirements.
Uphold and practice the principles and policies of the SCA Compliance program
Qualifications
Bachelor's degree in Actuarial Science , Mathematics, Statistics, Economics, healthcare informatics, healthcare administration or related field. Master’s degree preferred.
8+ years experience in healthcare analytics. Strong knowledge of and experience working with healthcare data required
Experience in physician compensation, billing, capitation, risk adjustment, CPT coding, and resource-based relative value scale (RBRVS)
Hospital and/or ASC operations experience a plus
Experience with managed care contract terms analysis
Clinical code knowledge (ICD, CPT, Rev Codes, etc.) related to medical claims/utilization data required
Advanced experience in Excel
MS SQL Server (Strong command over T-SQL) required
Tableau BI tool experience preferred
Acute attention to detail and strong analytical and critical thinking skills
Strong written and verbal communication skills including the ability to communicate results of data analysis to a variety of stakeholders
Travel to health plan meetings, company meetings, center visits, etc. (10%)
USD $118,000.00/Yr. USD $150,000.00/Yr.