Sr Director, Performance Suite Analytics

Your Future Evolves Here

Job Description

Put your passion where it meets purpose! Evolent attracts some of the brightest minds in health care. Surround yourself with talented, driven colleagues who share a passion for better health outcomes and a more connected care journey. We are hiring for a Senior Director to join our Finance Team.

The candidate selected for this role will be part of a team who thrives on driving analysis and support for Evolent's fast growth and innovative risk-based Performance Suite business.

 Collaboration Opportunities:

This person will work cross-functionally with many departments across the organization to analyze, communicate, and negotiate client performance and contracting.

What You’ll Be Doing:

• Serve as the lead advocate and owner for clean data transfer between Evolent and its customers in the Performance Suite where Evolent does not pay claims
• Establish ideal data transfer protocols during client onboarding and implementation, and refine on an ongoing basis
• Establish and run data quality assurance checks on a regular basis to uncover irregularities in data submitted from clients and work cross-functionally to resolve
• Apply post-pay audit and payment integrity methods and techniques to ensure claims were paid according to policy
• Coordinate with internal teams to ensure clean and consistent tracking of Evolent’s covered membership and claims
•  Synthesize complex analyses into succinct presentations for communication to key internal and external executive stakeholders
• Partner with team members across the organization to ensure accurate and timely delivery of the claim financial scope reconciliation
• Review claims financial reconciliation outcomes, identifying areas for additional analysis and refinement, and confirm claims are within our financial scope.
• Connect reconciliation outcomes claims scenarios surfaced to relevant stakeholders for vetting, including Performance Suite, Product, Claim Ops and Clinical teams.
• Develop standardized processes, templates, and collateral for key client-facing financial activities
• Clearly outline potential risks and opportunities related to partner data, enabling leadership to better resource solutions, negotiate contractual terms, or settlements.
• Advocate for data accuracy with existing and potential partners, negotiating to ensure data credibility aligns with contracts and allows us to confirm our scope or identify payment integrity issues.
• Contribute to the establishment of best practices and gold standard in contracting
• Review and make contracting, pricing, and penalty recommendations for partners based on their ability to meet critical data requirements.
• Support partner operational data assessment during implementation and make recommendations for additional fees or risk loads.
• Own and lead execution of recommendations for future process optimization.
• Lead continued refinement and enhancement of reconciliation logic
• Manage any vendor relationships if a vendor is used to surface or validate recon outcomes.
• Support contract negotiation process with clients through thought leadership, strategic analyses, and presentation materials
• Participate in execution of complex deal structures for potential new and existing clients
• Foster alignment with Performance Suite and Strategic accounts on client financial negotiations
• Perform ad hoc client-specific analyses to support strategic decision-making

Qualifications - Required and Preferred:

• Bachelor’s degree in quantitative field (Required)
• 6+ years of experience working in a medical economics-related field (Required)
• Exceptionally strong analytical abilities, with a track record of identifying insights from financial information and translating into recommendations (Required)
• Ability to multitask, prioritize, adapt to change, work well under pressure in an entrepreneurial environment, and manage a project from start to finish (Required)
• Able to work independently to meet deadlines within time constraints (Required)
• Strong interpersonal skills to coordinate with people across all areas of the organization in a fast-paced, dynamic environment (Required)
• Strong communication skills with ability to work with technical and non-technical audiences (Required)
• Ability to handle ambiguity and demonstrate initiative to identify and resolve problems (Required)
• Experience delivering executive-level presentations for strategic decision-making (Required)
• Basic knowledge of risk/capitation contracting (Required)
• Experience with project and stakeholder management (Required)
• Familiarity with healthcare claim processing (Preferred)
• 2+ years experience at payer or management consulting firm (Preferred)
• Basic knowledge of GAAP (Preferred)

Technical Requirements:

We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. 

Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status. If you need reasonable accommodation to access the information provided on this website, please contact [email protected] for further assistance.

The expected base salary/wage range for this position is $150,000-160,000. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.