Region Director Payer Analytics Economics Central

As our Region Director, Payer Analytics & Economics, you will be responsible for the comprehensive financial analysis, strategic pricing, and payer contract modeling activities for a defined Division payer portfolio.

Every day, you will oversee and provide critical analytical and pricing expertise for evaluating, negotiating, implementing, and maintaining managed care contracts. You will recommend and act on strategies to maximize reimbursement and market share, including developing new managed care products consistent with strategic plans. You will also educate key stakeholders and expertly navigate adverse or politically challenging situations, given the direct financial impact on physician incomes and organizational performance.

To be successful in this role, you will possess extensive experience in managed care financial analysis, strategic pricing, and payer contract negotiation, preferably within a large healthcare system. Strong leadership, communication, and interpersonal skills will be essential for influencing stakeholders, negotiating effectively, and managing high-stakes financial decisions that impact both providers and organizational financial health.

• Manage the labor and operations of the Division Payer Analytics & Economics team(s) including the hiring, orienting, developing and managing of staff.
• Oversee quality control and quality assurance of Payer Analytics & Economics analytics deliverables and financial models to support the negotiation and implementation of appropriate reimbursement rates associated language, between physicians/hospitals and payers/networks for managed care contracting initiatives.
• Review and accurately interpret contract terms, including payer policies and procedures to appropriately contract performance and influence strategic pricing strategies.
• Monitor contract financial performance. Analyze and publish managed care performance statements and determine profitability.
• Provide training and oversight of the modeling of proposed/existing payer contracts negotiated by payer strategy and operations, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
• Oversee and prepare complex service line reimbursement analyses and financial performance analyses. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provisions, parameters and rate structures aimed at establishing appropriate reimbursement levels. Prepare and effectively present results to senior leadership, and other key stakeholders, for review and decision making activities.

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Required

• Bachelors Other in Business Administration, Accounting, Finance, Healthcare or related field; a
• Minimum of eight (8) years of experience in contributing to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.
• Minimum of three (3) years of healthcare or financial leadership experience.
• Managed Care and Healthcare experience strongly preferred

Preferred

• Masters 

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.