Payer Contracting Manager - Payer Rate Development and Payer Performance Reporting

Lead Payer Contracting

The Payer Contracting Manager of Payer Rate Development and Payer Performance Reporting leads payer payment rate modeling using Epic and other related tools for all Intermountain Health regions. This involves applying data and ad hoc scenarios to detailed payment methodologies, historical data, and projected changes, ensuring results vital to the financial success and revenue growth for Intermountain Health (>$1 billion).

Reports and Analysis

• Produces analytical solutions (modeling, reports, dashboards, tools, etc.) for leadership and stakeholders across the organization.
• Develops payer performance reports that answer multiple related questions and reports with linked content, drilldown, and nested parameters.
• Ensures data accuracy and creates basic QA test plans, validating data according to enterprise-wide standards.

Contract Negotiation and Implementation

• Serves as a content expert for payer contract rates and methodologies, developing new payment models.
• Supports Payer Contracting in writing and reviewing contract language, and processes for Epic contract builds.
• Makes recommendations to department management based on payer contract negotiations.
• Works directly with Epic to identify or develop solutions for payer contract negotiations.

Communication and Project Management

• Oversees and coordinates communication and messaging to internal parties regarding new contract rates and terms, rate structure, and payment methodologies.
• Manages timelines and deliverables for projects involving contract builds.
• Supervises supporting contract analysts to ensure project goals are met.

Qualifications

• Bachelor’s Degree with five years of analytics experience.
• Demonstrated proficiency and advanced working knowledge of MS Excel, Strata, Epic, and other tools.
• Advanced knowledge of database design principles and industry-standard BI, statistical, or analytical tools and technologies.
• Epic Resolute Billing Expected Reimbursement Contracts Administration certification with three years of experience.
• Five years of experience in a role requiring management of projects and accountabilities.
• Knowledge of state and CMS program payment methodologies and regulations.

Physical Requirements

• Ongoing need to see and read information, labels, monitors, documents, and assess customer needs.
• Frequent interactions with customers requiring communication and understanding of spoken information, needs, and issues.
• Manual dexterity for manipulating complex and delicate equipment with precision and accuracy.
• Ability to sit or stand for long periods, perform work on a computer, telephone, or other equipment.
• Utilize full range of movement to transport, pull, and push equipment.
• Work on hands and knees and bend to set-up, troubleshoot, lift, and carry supplies and equipment.
• Typically includes items of varying weights, up to and including heavy items.